Point32Health challenges Aduhelm, threatens coverage for 1.1M members 

Point32Health may not cover Biogen’s new Alzheimer’s treatment, Aduhelm, for its commercial members unless the price is reduced.

Advertisement

Point32Health CMO Michael Sherman, MD, told The Boston Globe that the drugmaker was favoring “excessive corporate profits” with the $56,000 price tag over patient interests. Dr. Sherman believes the price of the treatment should be closer to $5,600, 10 percent of the current cost. 

While no coverage decisions have been made as of yet, Dr. Sherman said Point32Health has explored limiting coverage or tracking drug efficiency with patients should it be used.

The insurer, which was formed as a merger between Tufts Health Plan and Harvard Pilgrim Health care, serves 2.2 million members across New England, though 1.1 million are in government-funded programs like Medicare Advantage where coverage of the drug will depend on Medicare’s determination.

Biogen has received widespread backlash over both the approval of Aduhelm and its pricing of the treatment.

Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit

Advertisement

Next Up in Compensation Issues

Advertisement

Comments are closed.