Aduhelm In Medicaid: States Must Cover, CMS Official Says
Medicaid’s pharmacy director says the Biogen Alzheimer’s drug is ‘currently a covered outpatient drug.’ As the payer of last resort, Medicaid could find itself significantly impacted by a Medicare national coverage decision.
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Executive director Schwartz suggests Congress may turn its attention to the advisory commission’s proposal to revise Medicaid coverage for drugs approved under the accelerated approval pathway in the next year or two.
Proposed reimbursement decision to be released by 12 January 2022, with a final decision the following April. Biogen's Aduhelm expected to be covered in the interim. Medicare will not consider the cost of treatment in the analysis, but cost may have been a factor in initiating the process.
Committee Chair Maria Cantwell (D-Wash.) solicits advice from witnesses for additional authorities to conduct oversight of PBMs and pushes for a GAO study.