Will Medicare cover Alzheimer’s drugs like Aduhelm? That decision-making process is underway.
“Alzheimer’s is a devastating illness that has touched the lives of millions of American families and as CMS opens our National Coverage Determination analysis, we invite interested stakeholders to participate,” CMS Administrator Chiquita Brooks-LaSure said in the statement. “We want to consider Medicare coverage of new treatments very carefully in light of the evidence available. That’s why our process will include opportunities to hear from many stakeholders, including patient advocacy groups, medical experts, states, issuers, industry professionals, and family members and caregivers of those living with this disease.”
Want to learn more about clinical trials
for Alzheimer’s and dementia?
Check out the Lilly Trial Guide.
The first drug of its kind to be FDA-approved, Aduhelm’s estimated cost has been criticized widely for being sky-high, and is even the subject of calls for investigation by members of Congress.
According to Biogen, the estimated cost is based upon an infusion that patients will receive once every four weeks, with dosage determined by a person’s weight. If the drug recipient weighs what Biogen pegged as average adult weight, 163 pounds, each infusion will cost an average of $4,312. For 12 infusions per year, that makes the cost some $56,000 annually.
Experts say affording the drug could be especially complicated for people without access to quality healthcare and to the very large population of people with Alzheimer’s on Medicare. Further, it will be a burden on the Medicare system at large.
According to the AARP, Medicare currently supports some 44 million beneficiaries—some 15 percent of the U.S. population. One in 10 beneficiaries relies solely on Medicare for health care coverage. As the U.S. general population ages, the total number enrolled is expected to rise to 79 million by 2030.
“I think the hard thing is that people have longed for a drug that would treat or cure Alzheimer’s and have a lot of hope that this might be the drug,” Tricia Neuman, senior vice president of the Henry J. Kaiser Family Foundation and executive director of its program on Medicare policy, told Being Patient, “but this could be a high price to pay for a drug that may or may not have much of an effect.”