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Medicare Will Not Fully Cover Aduhelm, the Controversial—and Costly—Alzheimer’s Disease Drug

Medicare said Tuesday it will limit coverage of a $28,000-a-yr Alzheimer&#8217s drug whose positive aspects have been extensively questioned, a key enhancement in the nation&#8217s tug-of-war about the fair worth of new medicines that present tantalizing opportunities but arrive with prohibitive selling prices.

The preliminary determination from the Facilities for Medicare and Medicaid Solutions signifies that sufferers using Biogen&#8217s Aduhelm medicine will have to be portion of study attempts to assess the drug&#8217s effectiveness in slowing the progression of dementia. Medicare&#8217s nationwide coverage determination would come to be remaining this spring, subsequent a general public comment period and even further evaluation by the company.

The drug has sparked controversy because its approval by the Foodstuff and Drug Administration very last June, which arrived towards the advice of the agency’s exterior advisers.

Aduhelm&#8217s preliminary launch price of $56,000 a calendar year led to an maximize of almost $22 in Medicare&#8217s month-to-month “Part B” premium for outpatient care, the biggest at any time in greenback conditions but not percentage-smart. Medicare attributed about fifty percent of this yr&#8217s enhance to contingency arranging for Aduhelm.

Faced with skepticism above its treatment, Biogen recently slashed the value to $28,200, but Medicare enrollees were already on the hook for the $170.10 premium. Well being and Human Solutions Secretary Xavier Becerra has directed Medicare to reassess the high quality maximize.

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