CMS kicks off 9-month process on whether to limit coverage to Biogen's new Alzheimer's drug
The Centers for Medicare & Medicaid Services late Monday opened a formal process, rarely done for new therapeutics, to carefully review whether it will limit coverage nationwide for monoclonal antibodies targeting amyloid for the treatment of Alzheimer’s disease, including Biogen’s newly approved Aduhelm.
While it remains unlikely that CMS won’t end up paying for Aduhelm (Medicare officially draws the line at care that is “not reasonable and necessary,” but CMS denies only about 3% of claims submitted by hospitals and physicians), the stakes are high as Biogen expects that about 80% of patients eligible for Aduhelm are covered by Medicare, and private insurers are likely to follow the federal government’s lead.
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