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Shortly after the controversial Biogen drug Alzheimer’s was approved in the U.S. last year, a pair of state Medicaid directors tried to ring alarm bells.

In a terse letter, they implored the Biden administration to ensure Medicare covers the medicine, despite limited effectiveness and a $56,000 price tag. Their reasoning was simple. If Medicare reacted to the highly questionable approval by withholding or restricting coverage, Medicaid would be left holding the proverbial bag, because by law it must cover drugs endorsed by the Food and Drug Administration.

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