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The Virtues Of Predictability: US Medicare’s Review Of Aduhelm Coverage

Executive Summary

Medicare’s decision to initiate a formal review of coverage for the newly approved Alzheimer’s agent is a highly unsettling development in many respects. It is also probably the best possible news for Biogen and Eisai at this point.

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Aduhelm & Medicare: HHS Reconsideration Of Premium Hike May Ease Blowback On Coverage

Biogen’s Alzheimer’s drug may not cause as much of a financial headache to American seniors as expected, which could dampen criticism of Medicare’s upcoming coverage determination. But questions remain about what exactly HHS will be able to do about Part B premiums.

Who Needs The BBB? Aduhelm Shows Medicare Price ‘Negotiation’ Is Already Here

Biogen is making clear that its decision to cut the price of the Alzheimer’s therapy Aduhelm is in no way tied to the upcoming US Medicare coverage decision for the treatment. But it still shows how Medicare can already ‘negotiate’ prices even without explicit statutory authority.

Aduhelm And The Power Of Doubt

CMS is famous for not being able to negotiate prices – and its payment for physician-administered drugs notoriously incentivizes higher prices. Yet, as the Biogen/Eisai Aduhelm experience shows, CMS can on occasion have a profound impact on product launches when it chooses to.

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