Medicare/Medicaid may not cover cost of new Alzheimer’s drug

MM Curator summary

[MM Curator Summary]: As the initial Aduhelm coverage story concludes, it looks like coverage will be limited to those in clinical trials for Medicare and Medicaid.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


CHARLOTTE, N.C. — The Centers for Medicare and Medicaid Services (CMS) is proposing to restrict payment for a group of drugs to treat Alzheimer’s disease. That means patients may have to pay the full cost if they want to take the drug.

What You Need To Know

  • The Centers for Medicare and Medicaid Services is proposing to only cover the cost of approved monoclonal antibodies that targets amyloid for the treatment of Alzheimer’s disease in clinical trials
  • Currently, aduhelm (aducanumab) is the only FDA-approved drug in this group
  • The out-of-pocket cost for the drug is $28,000 per year
  • In a statement, CMS said while they see potential promise in this drug, they also see potential harm

Brian Van Buren understands the toll the disease can take because he deals with a lot of day-to-day frustrations firsthand. He has early-onset Alzheimer’s, which currently affects his short-term memory. He can recite most of the Gettysburg Address from memory, but can’t remember what he did two days ago.

“Last Sunday was my birthday, I remember that,” Buren said. “My friends took me out for dinner. I remember what I ate, but then Monday, Tuesday I don’t remember.”

Currently, there is only one FDA-approved Alzheimer’s drug that treats the disease, and not just the symptoms. It’s called Aduhelm.

In a statement, CMS said while they see potential promise in this drug, they also see potential harm and want more information before potentially making the drug more widely available. 

Some doctors, however, are worried about the effectiveness and side effects such as headaches, dizziness, vision changes and brain bleeds. That’s why the Centers for Medicare and Medicaid Services is proposing only to cover this class of drugs if the patient is taking it in clinical trials.

“That is unfortunate because that is going to eliminate a lot of people,” Buren said. “They can’t afford that kind of money, in terms of medication.”

If Buren wanted to take the drug, he would have to pay $28,000 out of pocket per year. He doesn’t usually qualify for clinical trials because of his pre-existing conditions.

“Very few minorities are involved in clinical studies,” Buren said. “Mostly because they have situations like mine where things eliminate them.”

Alzheimer’s runs in his family. Three of his relatives have died from the illness, and he believes it will also take his life. But he is holding out hope that he has access to a treatment one day that could change the progression of his illness.

The Alzheimer’s Association says this proposal restricts care and creates barriers. To see their statement, click here.


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