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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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.
No one thinks it is a good idea for the US FDA Commissioner or some other higher up political actor to decide when and if to approve new drug applications. But it might not be so bad if the scientific staff at FDA paid a bit more attention to ‘political’ issues before making some decisions.
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.