On June 7, 2021, the FDA granted accelerated approval to a new Alzheimer’s drug called Aduhlem (or its generic name, aducanumab). The list price for this product is $56,000 per year, and there has been significant debate in the scientific community over the efficacy of this medication. Currently, Medicare is going through a National Coverage Determination process to decide whether they will cover this drug. If Medicare chooses not to cover Aduhelm, state Medicaid programs will be required to cover it per the Medicaid Drug Rebate Program, which could result in large spending increases for states.
NAMD sent a letter to CMS requesting that they take steps to mitigate this spending risk for states. Specifically, CMS could require Medicare to cover Adulhelm. Alternatively, HHS could add Aduhlem to the list of drugs that can receive restricted coverage under the Medicaid Drug Rebate Program. This would give states the same flexibility available to other payers to scale back or pause coverage until more reliable evidence of efficacy emerges.