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BLOG — Aduhelm’s Price Cut Misses the Mark

After months of criticism, Biogen caved to public pressure and lowered the cost of its controversial Alzheimer’s treatment, Aduhelm. Unfortunately, the drug’s sky-high launch price and contentious accelerated approval have already harmed consumers across the country.

Biogen’s recent price change does not alter the fact that, besides being outrageously priced, Aduhelm is an unproven, potentially dangerous drug—a drug Medicare simply should not cover.

Government officials, in announcing the largest Medicare premium increase in history, cited the cost of Aduhelm as “requiring additional contingency reserves.”

Seniors will now pay an additional $260 a year — in no small part due to Biogen’s decision to release Aduhelm at an eye-popping price of $56,000 per person.

In fact, CMS was so concerned about the treatment’s price tag that the increase came before an official ruling on whether the federal health program will even cover Aduhelm.

CMS can—and should—reevaluate those Part B premium hikes. Seniors should not have to pay almost 15 percent more each year for a controversially approved drug.

But Aduhelm’s approval goes beyond its financial impact.

Concerns about the effectiveness and safety of the drug are so strong that major health plans—including ACHP member Point32Health—have announced they won’t cover the drug, and state Medicaid programs are already planning to seek waivers to exclude the drug from their formularies. European officials have recommended not approving the treatment at all.

By refusing to cover Aduhelm, CMS can reassure Americans that Medicare coverage decisions are driven by the wellbeing of seniors and quality of care.

Short of rejecting coverage, CMS can ensure national consistency in how they review appeals of Aduhelm coverage and should exclude the drug’s appeals from impacting Medicare Star ratings.

With Congressional leaders driven to pass prescription drug pricing reform, federal policymakers are in a position to set a precedent in how they weigh clinical evidence against the marketing power of the pharmaceutical industry. Let’s hope evidence and effectiveness prevail.