December 22, 2021
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.
Government officials, in announcing the largest Medicare premium increase in history, cited the cost of Aduhelm as “requiring additional contingency reserves.”
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.
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.
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.