Lou Portero

Urban Health Today

On January 11, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated National Coverage Determination (&ldquo;NCD&rdquo;) decision for anti-amyloid monoclonal antibodies for the treatment of Alzheimer&rsquo;s disease.Although this decision is still awaiting public comment and further agency evaluation before final decisions are made on April 11, it has sparked numerous discussions&mdash; good and bad.This coverage decision, if accepted would mean that Medicare will only cover the bills of patients with anti-amyloid monoclonal antibodies (specifically, Biogen&rsquo;s drug Aduhelm) who have participated in clinical trials to determine whether the drug showed a significant difference in effectiveness in terms of decline in cognition and function, and safety.Biogen has argued that Medicare&rsquo;s decisions were not in favor of patients with Alzheimer&rsquo;s as the clinical trials can take months or years to complete. According to Biogen, &ldquo;hundreds of Alzheimer&rsquo;s patients&hellip;are progressing each day from mild to moderate disease stages where treatment may no longer be an option.&rdquo;Many believe Medicare&rsquo;s decision was made because of the exorbitant cost of Aduhelm, which was a problem for Medicare premiums and out-of-pocket costs. However, Medicare officials have stressed that clinical trials are being conducted to determine the effectiveness and necessity of using these drugs to treat Alzheimer&rsquo;s patients enrolled in the program, and not because of the cost of Aduhelm.Biogen originally marketed Aduhelm at a price of $56,000 per year, which resulted in a nearly $22 increase in Medicare&rsquo;s monthly &ldquo;Part B&rdquo; premium for outpatient care. Medicare attributed their plan&rsquo;s price increase to the exorbitant cost of Aduhelm. After careful consideration, Biogen lowered the price of the drug to $28,200, which has prompted Medicare to reconsider its premium increase.Source: <a href="https://news.yahoo.com/medicare-limits-coverage-28-000-213046952.html">https://news.yahoo.com/medicare-limits-coverage-28-000-213046952.html</a>

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Medicare’s Decision for Coverage of Alzheimer’s Drug Aduhelm

On January 11, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated National Coverage ...

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