The recent approval of a high-price Alzheimer’s drug is raising questions about who will have access to a treatment that could cost Medicare billions of dollars in coming years.
Biogen Inc. priced the drug Aduhelm at $56,000 a year. Wall Street analysts estimate it could eventually surpass $5 billion in yearly sales, mostly paid by Medicare, while some health economists warn the bill would be multiples higher.
Medicare normally pays unconditionally for approved medicines. To limit the financial hit from Aduhelm, however, Medicare could restrict access, former U.S. health officials and health-policy experts said.
"Medicare can’t afford to treat this as business as usual," said Andy Slavitt, a former Medicare acting administrator and Biden administration senior adviser.
The Centers for Medicare and Medicaid Services, the agency overseeing Medicare, is reviewing Aduhelm’s approval and will have more information soon about its coverage, a spokesman said.
"Whether or not that drug will be covered by Medicare and Medicaid is an outstanding question, something HHS will have to deal with," Department of Health and Human Services Secretary Xavier Becerra said during an interview live streamed on YouTube on Thursday.
"We’re going to be making some pretty heady decisions about how it’s treated, if it will be reimbursed, how much, and so forth," he added.
Meanwhile, Biogen said it wants to limit who gets Aduhelm to Alzheimer’s patients in the early stage of the disease with mild symptoms.
The federal government and the company may need to move quickly. "I’m not quite certain how we’re going to accommodate all the patients who want it," said Richard Isaacson, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian hospital.