The first new Alzheimer’s drug in nearly 20 years has received approval from the Food and Drug Administration.
That's the good news. The flip side is the cost, which is raising concerns for patients and payers, particularly Medicare.
That hefty price tag would raise Medicare premiums broadly, and some patients who are prescribed the medication could face copayments of about $11,500 annually, according to a research report published Thursday by the Kaiser Family Foundation.
Because Aduhelm is not a cure, patients could incur these annual out-of-pocket costs for years to come.
Alzheimer’s disease is estimated to affect about 6 million Americans, the vast majority of whom are age 65 and older and therefore eligible for Medicare.
As an intravenous-infused medication administered by physicians, Aduhelm will be covered under Medicare Part B, which generally covers FDA-approved physician-administered medications that are reasonable and necessary for the individual patient.
Decision-makers at the Centers for Medicare & Medicaid Services may opt to undertake a National Coverage Determination process that could set some limits on the conditions of Medicare coverage for Aduhelm based on the drug’s clinical effectiveness.