WASHINGTON — Federal officials on Monday announced Medicare will start a process that could limit seniors’ access to the controversial new Alzheimer’s drug, Aduhelm — the first signals from the key health program about what will be an enormously consequential decision for Biogen, the Medicare program itself, and people with the disease.
The process, called a National Coverage Determination analysis, ensures that coverage for the drug is uniform across the country instead of leaving decisions to regional contractors. The tool is rarely used for drugs, and Medicare announced its decision to use it much more quickly than is typical — in just 12 days after receiving a formal request instead of the previous record of 36 days, according to Washington Analysis.
Notably, if Medicare were going to pay for any Alzheimer’s patient’s treatment with Aduhelm, it likely would not need to use the tool. But its decision has enormous consequences since most of the patient population for the $56,000 therapy is covered by the federal health care program.
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