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Draft decision denies coverage for Alzheimer’s treatment

CMS is accepting public comment on its website for the next few weeks on its preliminary decision. It will announce a final decision by April 11.
Published: Jan. 20, 2022 at 6:28 PM CST
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CEDAR RAPIDS, Iowa (KCRG) - The Centers for Medicare and Medicaid Services says a drug approved to treat Alzheimer’s doesn’t show enough benefit to warrant coverage for patients. CMS issued a draft decision on Aduhelm, saying the risks may outweigh any promise of a treatment. The Alzheimer’s Association says it’s a disappointment for those living with the disease.

According to health policy experts, it’s the first time CMS hasn’t offered some kind of coverage for an FDA-approved drug. Aduhelm is monoclonal antibody treatment. The FDA approved it last June to slow the cognitive decline of those in the early stages of Alzheimer’s, though even at the time, there were questions on its effectiveness. In its draft decision, CMS said while there may be potential for promise for this treatment, there is also the potential for harm from side effects.

The Alzheimer’s Association says this is a major setback for patients who were hopeful for a treatment option. Though the cost of Aduhelm has come down, it’s still $28,000 a year, which, without coverage, makes it out of reach for most patients. “This was the first drug in two decades to have come out for Alzheimer’s, and it’s the first one to slow the progression of the disease,” says Lauren Livingston, Communications Director for the Alzheimer’s Association, Iowa Chapter. “It gave us a glimmer of hope [as well as] people with Alzheimer’s and their families, and to deny access is just taking that glimmer of hope away.”

The Alzheimer’s Association is pushing back on the decision, by talking to lawmakers and sharing stories of those directly affected. CMS is accepting public comment on its website for the next few weeks on its preliminary decision. It will announce a final decision by April 11. If it is finalized, only approved clinical trials on Aduhelm would be covered.

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