Bio­gen push­es for broad CMS cov­er­age of Alzheimer's drug — while Eli Lil­ly looks to es­cape an NCD

The nine-month quest for CMS to fig­ure out how (or how not) to cov­er Bio­gen’s new Alzheimer’s drug Aduhelm, and po­ten­tial­ly more amy­loid-tar­get­ed mon­o­clon­al an­ti­bod­ies, kicked off in earnest on Tues­day with an open pub­lic hear­ing of com­ments from var­i­ous stake­hold­ers stress­ing the pros and cons of cov­er­ing this new, pricey drug with un­known clin­i­cal ben­e­fits.

Bio­gen and its af­fil­i­ates stressed the need for a quick and pos­i­tive Na­tion­al Cov­er­age De­ter­mi­na­tion from CMS as oth­er physi­cians and a speak­er from ICER called on CMS to not cov­er the drug or to lim­it cov­er­age in cer­tain ways as Bio­gen’s clin­i­cal tri­als didn’t show strong signs of clin­i­cal ben­e­fit, the $56,000 an­nu­al price tag doesn’t match those ben­e­fits, and as the tri­als didn’t ad­dress a di­verse group of pop­u­la­tions, like African Amer­i­cans or Lat­inx, who are fre­quent­ly af­fect­ed by Alzheimer’s.

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