Medicare Premiums and Aduhelm: The Political Headache Continues
CMS took pains in its final national coverage determination to try to mend fences with FDA; how the NCD will play with Medicare recipients remains an open question, especially since the Alzheimer’s-induced premium hikes remain in effect.
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Medicare will be closely watching for pricing decisions by Eli Lilly, Eisai and Roche once the companies gain US marketing approval for their amyloid-directed monoclonal antibody drugs for Alzheimer’s disease.
Medicare Registry-Based Studies For Alzheimer’s Drugs Still ‘Challenging’ Prospect – Former CMS Official
Medicare coverage with evidence development requirements for Alzheimer’s drugs that obtain traditional approvals may be more involved than they appear.
Medicare has clearly won the battle when it comes to prevent the Alzheimer’s therapy Aduhelm from consuming billions in taxpayer spending based on data that the payor agency finds unconvincing. But in finalizing a policy that has broad implications for all FDA approved therapies, it may be starting a war that it cannot win.