CMS is continuing to review Aduhelm coverage in an “unprecedented” move, James Chambers, PhD, a Tufts Medical Center researcher, told The New York Times on Dec. 31. The review is expected to resolve in a preliminary decision in January and a final decision in April.
The scope of Medicare’s decision is twofold: it provides coverage for nearly 80 percent of potential Aduhelm patients who are Medicare-eligible and sets a strong coverage precedent that private insurers also follow, according to the Times. If covered, it would be one of Medicare’s largest drug expenditures.
Payers including UnitedHealthcare and Anthem are waiting on more information over the drug’s effectiveness — especially paired with its initial annual $56,000 price tag. Biogen has since reduced Aduhelm’s price to $28,000 annually.
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