Of Price And Premiums: Medicare Has Put Alzheimer’s Drug Sponsors On Notice
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.
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Medicaid advisory panel members suggest states should have the same flexibility as Medicare to adopt coverage with evidence development requirements for drugs with limited supporting evidence.
But premiums in future years made need to keep pace with accelerating Medicare spending on Alzheimer’s drugs.
Donanemab results due next year have a good chance of persuading CMS to offer unrestricted coverage, Lilly argues, even though the drug might just have accelerated approval at that point. ‘We believe that having two positive pivotal trials should meet that high level of evidence.’