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Medicare’s coverage decision is considered crucial to the future of Aduhelm, which is priced at $28,200 per patient per year. About 80 percent of patients eligible for medication are old enough to be covered under Medicare.
Biogen initially priced the drug at $56,000 per year, but cut the price in half last month after months of weak sales. Prior to Biogen’s price reduction, Medicare’s actuarial division, acting without knowing what the coverage decision would be, One of the biggest-ever increases in Medicare Part B premiums For 2022, partly due to the possibility of Aduhelm coverage.
After Biogen’s price cut, advocacy groups for Alzheimer’s patients urged CMS to lower the premium increase. On Monday, Xavier Becerra, secretary of health and human services, said: Instruct the CMS to re-examine the premium increase “Given the dramatic price change of the Alzheimer’s drug Aduhelm.”
Medicare officials need to determine coverage based on whether a drug is “reasonable and necessary,” and price was not a factor in their decision, officials said in a briefing with journalists.
Acknowledging the unusual nature of the decision, Fleisher said, “The CMS is using the power granted by Congress to determine whether medication is reasonable and necessary, meaning that the benefits of improving cognition outweigh the harms in the Medicare population. ”
Various advocacy groups for patients, including the Alzheimer’s Association, have pushed for approval of the drug and Medicare coverage, expressing great disappointment at the agency’s preliminary ruling.
Harry Johns, CEO of the Alzheimer’s Association, said in a statement that the decision amounts to “shocking discrimination against anyone with Alzheimer’s disease” and that “with this approach, access to treatment would now only be available to a privileged few, those with access to research institutions, exacerbating further health inequalities.” and it creates.”
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