Medicare Will Not Fully Cover Aduhelm, the Controversial—and Costly—Alzheimer’s Disease Drug

Medicare mentioned Tuesday it’s going to restrict protection of a $28,000-a-year Alzheimer’s drug whose advantages have been broadly questioned, a significant improvement within the nation’s tug-of-war over the truthful worth of recent medicines that supply tantalizing potentialities however include prohibitive costs.

The preliminary willpower from the Facilities for Medicare and Medicaid Companies signifies that sufferers taking Biogen’s Aduhelm medicine must be a part of analysis efforts to evaluate the drug’s effectiveness in slowing the development of dementia. Medicare’s nationwide protection willpower would change into last this spring, following a public remark interval and additional analysis by the company.

The drug has sparked controversy since its approval by the Meals and Drug Administration final June, which got here in opposition to the advice of the company’s exterior advisers.

Aduhelm’s preliminary launch worth of $56,000 a yr led to a rise of almost $22 in Medicare’s month-to-month “Half B” premium for outpatient care, the most important ever in greenback phrases however not percentage-wise. Medicare attributed about half of this yr’s improve to contingency planning for Aduhelm.

Confronted with skepticism over its medicine, Biogen just lately slashed the worth to $28,200, however Medicare enrollees had been already on the hook for the $170.10 premium. Well being and Human Companies Secretary Xavier Becerra has directed Medicare to reassess the premium improve.


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