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Lilly Braces For Impact Of CMS Draft Coverage Decision On Biogen’s Aduhelm

 
• By Mandy Jackson

The draft national coverage determination, released shortly before Lilly CEO David Ricks spoke at the J.P. Morgan Healthcare Conference, said Medicare will cover anti-amyloid antibodies only for patients in clinical trials, severely limiting commercial potential for Biogen’s Aduhelm and near-term competitors.

Medicine stops disease domino effect
Biogen/Eisai's Aduhelm is first to market but other anti-amyloid drugs, like donanemab, will feel the NCD decision impact • Source: Alamy

The biggest milestone of 2022 for Biogen, Inc. and its Alzheimer’s therapy Aduhelm (aducanumab) – a Centers for Medicare and Medicaid Services (CMS) national coverage determination (NCD) for anti-amyloid antibodies – also is important for Eli Lilly and Company and its drug donanemab. CMS issued its draft NCD on 11 January, moments before Lilly CEO David Ricks took the virtual stage at the J.P. Morgan Healthcare Conference, where he said the proposed decision limiting Medicare coverage to patients enrolled in qualifying clinical trials is a worse scenario than Lilly expected.

“It looks like they're calling for coverage with evidence development, which isn't one of those middle scenarios that we had...

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