Roche/Lilly Oppose US CMS's Draft of Restrictive Medicare Coverage for Biogen Aduhelm

CompilationFan Dongdong

A few days ago, pharmaceutical companies fiercely competing in the field of Alzheimer's disease showed a rare display of unity

Not long ago, CMS closed the comment period for Aduhelm's draft restrictive coverage proposal, which would limit Aduhelm's health insurance coverage to those patients who qualify for clinical trials after examination

Other pharmaceutical companies developing Alzheimer's treatments are apparently feeling the same policy threat, and if the draft passes as it currently stands, the ruling will likely apply to other amyloid-like monoclonal antibodies in development as well.

Brandy Matthews, head of medical marketing for Eli Lilly's Alzheimer's drug candidate donanemab, urged CMS to individually evaluate mAb coverage based on clinical evidence for each candidate, rather than restricting all amyloid-clearing therapies on the market

Genentech, another Alzheimer's treatment developer, has also expressed concerns about its Alzheimer's disease candidates gantenerumab and crenezumab

Genentech also noted that limiting the coverage of the Aduhelm treatment to just-approved clinical trials will hinder the development of real clinical data for the therapy, evidence that will provide important clues for future innovation

In addition, Eisai and Biogen have previously publicly objected, saying that the US CMS has adopted different review standards for FDA-approved Alzheimer's disease treatments than other diseases

However, unlike biopharma, which is more concerned about the future performance of its Alzheimer's disease candidates, the US CMS proposal to limit the coverage of Aduhelm's medical insurance has received support from many outside parties

Aβ has even more voices, criticizing the US CMS for saying that Aduhelm and other Aβ therapies should not be covered by medical insurance at all, and that the US FDA should not have approved Aduhelm therapy at all

Biogen's ambition from the initial approval of Aduhelm to the quagmire now has also sounded the alarm for other pharmaceutical companies developing Alzheimer's disease treatments

Reference article: Roche, Lilly push back against CMS painting their Alzheimer's meds with the same brush as Biogen's Aduhelm