A key move in the nation’s tug-of-war over the fair value of new drugs that offer tantalising prospects but come with exorbitant pricing was announced Tuesday by Medicare, which will limit coverage of a $28,000-a-year Alzheimer’s drug whose advantages have been widely questioned. Patients receiving Biogen’s Aduhelm prescription will have to participate in clinical trials to assess the drug’s effectiveness in delaying the course of early-stage dementia as well as its safety, according to the Centers for Medicare and Medicaid Services’ initial judgement.
Following a public comment period and additional assessment by the government, Medicare’s countrywide coverage determination would be finalised by April 11. Clinical trials are required for the complete family of medications, monoclonal antibodies that fight against amyloid, a type of protein that forms plaques in Alzheimer’s disease, of which Aduhelm is a pioneer.
Because of Biogen’s initial launch price of $56,000 per year for Aduhelm, Medicare’s monthly “Part B” premium for outpatient care increased by about $22, the greatest rise in money terms but not in percentage terms. About half of this year’s rise was attributed to Aduhelm contingency planning, according to Medicare. Biogen’s recently dropped the price of their medicine to $28,200 in response to criticism, although Medicare enrollees were already responsible for the $170.10 premium.