Biogen Shares Fall as Medicare Proposal Restricts Alzheimer’s Treatment Coverage

Shares of Biogen were falling this week after the U.S. Medicare program’s proposal to severely limit coverage of new Alzheimer’s treatments included Biogen’s Aduhelm.

This may threaten to hurt the company’s sales of the controversial drug.

Aduhelm, given as a monthly infusion, is a monoclonal antibody designed to remove a type of brain plaque associated with Alzheimer’s Disease. Patients need to be monitored for potential side effects including brain swelling.

In a draft decision this week, the Centers for Medicaid and Medicare Services (CMS), which runs the government health plan for people over age 65, said it would cover Aduhelm, and similar treatments, but only for patients enrolled in approved clinical trials.

“It would appear that what is occurring is that cost is being put before the needs of Alzheimer’s patients,” Harry Johns, chief executive at the Alzheimer’s Association patient advocacy group, said to Reuters.

According to Johns, out of the one million or so Alzheimer’s patients who might now be eligible for Aduhelm, a few thousand at best could be enrolled in future CMS-approved trials, which will take years to conduct.

Aduhelm’s high price has raised concerns over the toll it might take on the Medicare program.

“We agree with CMS there is a need to obtain more clinical data on efficacy, which will be essential to ensuring these new medications deliver real value to patients before broadening access,” said Matt Eyles, president and CEO of trade group America’s Health Insurance Plans.

Biogen last month cut the medication’s list price by about half to $28,200 per year.

Only one of Biogen’s two pivotal trials has shown that Aduhelm can slow the rate of cognitive decline for Alzheimer’s patients.

“It is imperative to change this draft decision to be aligned with reimbursement for other therapies for progressive diseases, where patients have immediate and equal access to medicines approved by the FDA,” Biogen said in a statement.

Disclaimer: We have no position in any of the companies mentioned and have not been compensated for this article.