Will Medicare cover it? Drugs like Aduhelm are challenging its standard

This article is adapted from the latest STAT Report: Decoding Medicare: 10 key coverage decisions and how they’re made.

Medicare’s decision to withhold coverage for Biogen’s Aduhelm despite the Food and Drug Administration’s approval of the Alzheimer’s drug has revived longstanding questions about how the federal program determines whether it will pay for new drugs and devices.

In its decision, the Centers for Medicare and Medicaid Services cited a lack of sufficient evidence for Aduhelm’s effectiveness, and limited payment for the drug to patients enrolled in research studies. The agency said it would apply the same limits to other new Alzheimer’s drugs that, like Aduhelm, target amyloid plaques in the brain.

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