Medicare’s Final Coverage Decision On Alzheimer’s Drugs: Thoughts From A Former CMS Chief

Mark McClellan discusses whether CMS’s pending final version of the Medicare national coverage determination on Alzheimer’s drugs might change from the draft and whether the decision should be viewed as a precedent for drugs granted accelerated approvals.

National Medicare Coverage Policy Coming In April • Source: Alamy

In its upcoming final national coverage determination, the Centers for Medicare and Medicaid Services seems unlikely to withdraw its decision that Medicare will only cover amyloid-directed monoclonal antibody drugs for Alzheimer’s disease in the context of a randomized clinical trial, former CMS administrator Mark McClellan suggests.

A draft version of the national coverage determination on the drug class was released on 11 January, triggering concerns that...

More from Medicare

US Pricing Reform: New Products Offer ‘On Ramp’ To Implementation, Lilly’s Ricks Says

 
• By 

Eli Lilly's CEO argued that pricing reforms aimed at existing drugs would be “hard to sustain or justify,” while other companies suggested a growing interest in direct-to-consumer sales programs.

Pharma Cooperating With Trump On Direct Sale To Consumers, Pfizer CEO Says

 

Pfizer is in active discussions with Trump on MFN pricing and collaborating with peers on direct sales as an approach to lower drug prices, CEO Albert Bourla said.

Cuban: Drugmakers Are More Afraid of PBMs Than Trump

 
• By 

The billionaire investor said during a recent conference that brand drug manufacturers want to work with his Cost Plus Drug Co., but are afraid the PBMs will retaliate.

Most Favored Nation Pricing: Trump Ups Pressure On Voluntary Action, Clarifies Demands

 

The new 60-day deadline for striking a deal with the drug industry underscores the challenges the Administration may be having in developing non-voluntary policies to achieve MFN pricing in the US.

More from Government Payers

Could Study Questioning GLP-1 Cost Savings Impact CMMI Demo Chances?

 
• By 

The findings are consistent with some other research and likely are due to obesity patients becoming more connected to needed health care services.

Why Chiesi’s Raxone Faced A Decade-Long Wait For English Funding

 

Chiesi’s orphan drug Raxone has secured an English funding recommendation for the treatment of Leber's hereditary optic neuropathy, a decade after the orphan drug was approved for marketing. Chiesi told the Pink Sheet about its “long, and often challenging” road to reimbursement.

US Pricing Reform: New Products Offer ‘On Ramp’ To Implementation, Lilly’s Ricks Says

 
• By 

Eli Lilly's CEO argued that pricing reforms aimed at existing drugs would be “hard to sustain or justify,” while other companies suggested a growing interest in direct-to-consumer sales programs.