In order for a patient to qualify for coverage through Medicare, they must: (1) have mild cognitive impairment due to Alzheimer’s disease and have amyloid pathology; and (2) enroll in a clinical trial that addresses impact on cognitive function and adverse effects. The proposal has a 30-day comment period, after which CMS will review comments and make their final decision in April. CMS has stated that the price, now reduced to $28,000 per year, was not considered in the decision. To read the full press release and decision, click here and here, respectively.
The bill would require the FTC to investigate whether anticompetitive behavior by PBMs or intermediaries exists throughout the supply chain and to recommend policy initiatives to prevent such behavior. CBO estimated that 11 employees would be required to investigate the supply chain and make relevant recommendations, costing $2 million over the next two years. To review the cost estimate, click here.
The report identifies 554 prices hikes so far in January 2022, including 125 increases by Pfizer. Of the hundreds of price increases, 183 of them were increased by $100 or more and 188 of them are priced at over $5,000. The report calls on Congress to pass the Build Back Better Act, which would curb rising prices of already expensive life-saving medications. To read the full report, click here.
Sean Dickson spoke with reporters at NPR and STAT to discuss the CMS proposed NCD decision. Dickson was quoted by NPR saying that Aduhelm is “not something that we as taxpayers should be paying for if it's not actually going to help people.” To read the NPR and STAT articles, click here and here, respectively.
Stacie Dusetzina spoke with reporters at Inside Health Policy on applying the insulin cap demo to other disease areas. Dusetzina, as a member of MedPAC, is quoted saying, “I think that type of model, if it works well to improve adherence for beneficiaries, is maybe a good one for thinking about other chronic disease areas.” To read the full article, click here.
Rachel Sachs discussed the recent CMS proposed NCD decision regarding Aduhelm in a Health Affairs Forefront article. In addition to explaining what the proposed coverage with evidence development (CED) pathway means for Medicare beneficiaries, Sachs details the implications is has on all stakeholders. To read the full article, click here.
Rachel Sachs also spoke with reporters at Marketplace on the proposed NCD decision. Sachs points out to readers that “just because the FDA approves the drug doesn’t mean Medicare has to reimburse for it.” To read the full article, click here.