How will insurers cover a new Alzheimers drug?
It aims to help clear harmful clumps of a protein called beta-amyloid from the brain. The medication will be marketed as Aduhelm and is to be given as an infusion every four weeks. Biogen said the drug would cost approximately $56,000 for a typical years worth of treatment, and it said the price would not be raised for four years. They will likely request some documentation first that the patient needs the drug. Many plans will require doctors to submit records and other paperwork justifying the treatment before they agree to cover it. Insurers also will likely require pre-approval for brain scans needed to determine that the patient is a candidate for treatment, said Lance Grady of Avalere Health consultants. He noted that some plans also may want to see the results of a scan before they decide to cover the next infusion, which could delay treatment. Medicare is widely expected to cover the treatment. Insurers that offer private or commercial coverage also will pay for care that doctors deem medically necessary.