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The Value of Knowing: CMS Rejects Coverage of Lilly’s Amyvid – Except As Tool For Further Research

 
• By Michael McCaughan

CMS is proposing to deny coverage of Lilly’s Alzheimer’s “rule-out” diagnostic Amyvid. The decision is important for biopharma manufacturers for several reasons, both as a demonstration that the agency really will refuse to pay for FDA approved drugs—and for how CMS thinks it can actually use its authority to encourage research on effective AD therapies.

The Centers for Medicare & Medicaid Services is proposing only very limited coverage for Lilly’s recently launched diagnostic agent Amyvid, concluding that the evidence does not support routine payment for use of the scan to rule out Alzheimer’s in patients with early signs of dementia.

The proposed coverage decision

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• By Alaric DeArment and Cathy Kelly

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More from Government Payers

33 States Agree To Standardized Access Policies In Medicaid Sickle Cell Payment Demo

 
• By Alaric DeArment and Cathy Kelly

States also agreed to fund patient travel to specialized treatment centers as part of their participation in the Medicaid demo of CMS-negotiated outcomes-based contracts for Vertex/CRISPR's Casgevy and bluebird bio's Lyfgenia.

Part B Negotiation Proposal Would Lower Prices In MA, Private Plans Too, Stakeholders Complain

 
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The issue is attracting more attention as the 2028 deadline for implementing Medicare negotiated prices for Part B drugs approaches.

China Unveils Multiple Policies To Support Innovative Drugs Throughout Life Cycle

 
• By Xu Hu

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