“CMS has proposed an evidence-based coverage policy after experts reviewed all relevant publicly available evidence and feedback received from stakeholders,” said Chiquita Brooks-LaSure, the agency’s administrator.
The agency will accept public comments for 30 days and hopes to hear from Americans with Alzheimer’s, their family members, patient advocacy groups, medical experts and others. It is weighing the benefits versus the risks associated with Aduhelm.
Its maker, Biogen, last month announced it was cutting the price of the medication roughly in half to $28,200 a year.
Controversial from the start
The US Food and Drug Administration’s approval of Aduhelm in June raised many questions and concerns about the process, the drug’s efficacy and its annual cost. Biogen initially priced it at about $56,000 a year.
It’s also unclear how many patients will ultimately receive the medication. About a month after it initially approved Aduhelm, the FDA narrowed the group of patients who could receive it to those with mild cognitive impairment or milder states of the disease. Also, it’s unknown how many doctors will prescribe it because of questions surrounding its results.
Medicare premium spike
About $10 of the premium spike is due to Aduhelm, a CMS official told CNN in November. The rest stems from a general increase in health care prices and usage, as well as from congressional action that limited the rise in Part B premiums for 2021 amid the coronavirus pandemic.
Even though Medicare had not yet decided whether it will cover the medication, its actuaries must make sure the program has sufficient funding in case it does.
Biogen’s decision to drastically reduce the drug’s price prompted Becerra to call for a reevaluation of Medicare Part B’s 2022 premium.
“With the 50% price drop of Aduhelm on January 1, there is a compelling basis for CMS to reexamine the previous recommendation,” he said in a statement.
The agency said Tuesday it will announce further information on the reassessment when available.