Medicare Coverage Analysis Of Alzheimer’s Drugs Begins With Focus On Outcomes, Patient Eligibility

Proposed reimbursement decision to be released by 12 January 2022, with a final decision the following April. Biogen's Aduhelm expected to be covered in the interim. Medicare will not consider the cost of treatment in the analysis, but cost may have been a factor in initiating the process.

Decision Could Set A Precedent For Accelerated Approval Drugs

The Centers for Medicare and Medicaid Services has opened a Medicare national coverage analysis on amyloid-directed monoclonal antibody drugs for Alzheimer’s disease by seeking information on what treatment outcomes are meaningful to patients and which patients should receive treatment.

The national coverage analysis will also address whether specialists should be involved in prescribing and whether coverage should be limited to certain care settings, CMS notes in its 12 July...

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