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Amylyx ALS Drug May Drive Medicare Part D Redesign Efforts Based On Cost Sharing Concerns

 
• By Cathy Kelly

Medicare could be an important payer for the eagerly awaited drug because the program covers ALS treatments for patients under 65 as well as older ones. Meanwhile, a draft Institute for Clinical and Economic Review raises questions about the drug's cost effectiveness.

ALS Patients Worry Payers Will Restrict Access Based On ICER Analysis • Source: Shutterstock

A closely watched oral drug for amyotrophic lateral sclerosis from Amylyx Pharmaceuticals, Inc. would be covered by Medicare Part D and the pharmacy benefit in the commercial insurance market if it is approved. But patients accessing the drug through Medicare may be in for a significant cost sharing burden based on well-documented problems with the current design of the benefit program.

The situation could add momentum to stalled legislative efforts to redesign the Part D benefit in a way that addresses the cost sharing issues that have developed with the increasing availability of high-cost specialty drugs covered by the program

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Most Favored Nation Pricing Policy Floated In Medicaid, Coming Back To Medicare?

 
• By Cathy Kelly

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