Medicare limits coverage of $28,000-a-year Alzheimer’s drug

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Medicare says it will limit Alzheimer’s drug coverage to $28,000 annually, the benefits of which have been widely questioned

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WASHINGTON — Medicare said Tuesday it would limit coverage of a $28,000-a-year Alzheimer’s drug, the benefits of which have been widely questioned, a major development in the nation’s tug of war over the fair price of new drugs that have potential. offer but come with prohibitive prices.

An early determination from the Centers for Medicare and Medicaid Services means that patients taking Biogen’s EduHelm drug will have to be part of research efforts to assess the drug’s effectiveness in slowing the progression of dementia. After a public comment period and further evaluation by the agency, Medicare’s national coverage determination will become final this spring.

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The drug has sparked controversy since its approval by the Food and Drug Administration last June, which came against a recommendation from the agency’s outside consultants.

Aduhelm’s initial launch price of $56,000 per year led to a nearly $22 increase in Medicare’s monthly “Part B” premium for outpatient care, the largest ever in dollar terms but not percentage-wise. Medicare attributed nearly half of this year’s increase to the contingency plan for EduHelm.

Faced with doubts over its drug, Biogen recently slashed the price to $28,200, but Medicare enrollees were already on the hook for a $170.10 premium. Health and Human Services Secretary Javier Becerra has instructed Medicare to reevaluate the premium increase.

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