Medicare proposes coverage limits for Alzheimer’s drug Aduhelm

WASHINGTON — Medicare said Tuesday that it will cover a controversial - and pricey - new Alzheimer’s drug only for patients enrolled in qualifying clinical trials.

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The drug, Biogen’s Aduhelm, received FDA approval in June and was touted as the first new drug to treat the leading cause of dementia in nearly 20 years. Independent advisers argued at that time, however, that little evidence exists to support the drugmaker’s assertion that Aduhelm helps slow the brain-destroying disease.

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According to The Washington Post, Aduhelm is a monoclonal antibody, a “man-made protein that targets a sticky substance in the brain, called amyloid beta, which some scientists believe causes the memory-robbing disease.”

Specifically, the drug is designed to trigger an immune response that reduces the formation and build-up of amyloid plaques, the newspaper reported.

Tuesday’s initial determination from the Centers for Medicare and Medicaid Services means that patients taking Aduhelm will have to participate in research efforts to assess the drug’s effectiveness. The ruling will not be finalized until the spring, however, following a mandated public comment period and continued evaluation by the health agency.

Meanwhile, Biogen already slashed the price of Aduhelm from $56,000 annually to $28,200, but the price reduction came after the drug’s launch price forced CMS to increase its monthly “Part B” premium for outpatient care by $22, the largest-ever dollar-amount increase in the program’s history.

“With the 50% price drop of Aduhelm on Jan. 1, there is a compelling basis for CMS to reexamine the previous recommendation,” Health and Human Services Secretary Xavier Becerra said in a statement issued Monday.

To learn more about Aduhelm, what Medicare is doing to address the issue and how those decisions affect premiums, read the complete Washington Post report.

-- The Associated Press contributed to this report.

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