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Biogen stung as US limits coverage of Alzheimer's therapy

John Tozzi, Angelica Peebles and Robert Langreth, Bloomberg News on

Published in Health & Fitness

“With this approach, access to treatment would now only be available to a privileged few, those with access to research institutions, exacerbating and creating further health inequities,” said Harry Johns, chief executive officer of the Alzheimer’s Association.

Premium Increase

In November, ahead of the national coverage decision, Medicare increased premiums to cover the potential cost of Aduhelm and drugs like it, asking beneficiaries to pay about $11 a month more this year.

Biogen then cut Aduhelm’s $56,000-a-year list price in half in December to address the potential financial strain on the health system.

Health and Human Services Secretary Xavier Becerra on Monday directed CMS to review its premium increase in light of the price cut.

Biogen has said it expects 50,000 people to start getting monthly infusions of the medication in 2022. Early sales have been negligible — about $300,000 in the third quarter — and Biogen shares have given up the gains they recorded when the drug was approved. The company had estimated as many as 2 million Americans would be candidates for the drug.

Wider Fallout

 

The restriction on coverage is likely to affect other drug companies that have been working on similar drugs that target amyloid.

Eli Lilly & Co. is studying a potential competitor to Aduhelm, known as donanemab. The drugmaker hopes U.S. regulators will approve its product this year through an accelerated pathway, and it aims to follow with late-stage trial data in 2023 demonstrating clinical benefit. Lilly shares fell 1.7% in late trading on Tuesday.

“This is one of those middle scenarios we had talked about with investors before,” Lilly Chief Executive Officer David Ricks said of the decision by CMS at the JPMorgan Healthcare Conference. “I’m not super surprised.”

Ricks said providers and patients remain uncertain about whether the risk of emerging Alzheimer’s treatments is worth the benefit. That’s driving the “underdevelopment of this market,” he said.

“At the end of the day, when there’s full on Phase 3 data, I expect the field will shift and we’ll need to shift with it,” Ricks said.

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