Medicare officials have until Wednesday to issue a proposal on whether — and how — to cover Aduhelm. The FDA’s decision to approve the drug met with strong backlash and has already affected how much seniors pay for Medicare. Three FDA outside advisers quit over the decision, and a government watchdog is investigating how Aduhelm was approved. According to The Washington Post, complex dynamics at play have put CMS in a tricky position. Back in July, the agency launched a rare months-long review of how Medicare should cover the drug, which could create clinical guidelines narrowing who can access the treatment. What Medicare is deciding boils down to this: Is the drug “reasonable and necessary” for treating the disease? The answer to that question determines whether Medicare pays for the expensive drug. There are multiple paths the agency can take. CMS could simply decide not to cover the drug. Or it could cover Aduhelm in full. It could cover the drug for a specific patient population or let local Medicare contractors decide.
NCPA
