In a key decision, the Centers for Medicare and Medicaid Services (CMS) said today that Medicare will not pay for the controversial Alzheimer’s drug Adulhelm until it sees positive results from a government-approved trial.
In bureaucratic language: “Monoclonal antibodies directed against amyloid for the treatment of [Alzheimer’s Disease] provided outside of the CMS approved randomized controlled trials and trials supported by the NIH are nationally non-covered.” The determination is a draft, which is now subject to 30 days of public comment. CMS will issue its final coverage decision in April.
It is likely that private insurers will follow Medicare lead and refuse to pay for the drug. Manufacturer Biogen’s initial price for Aduhelm was $56,000-a-year for a typical patient. Faced with resistance from most physicians and little demand, Biogen cut the price in half to $28,000 in December. But even that price is far too steep for consumers to pay out-of-pocket.