Patient Advocacy Groups Butt Heads with CMS Over New Alzheimer’s Drug Coverage

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With the accelerated approval of lecanemab, Eisei and Biogen’s new Alzheimer’s drug, patient advocacy groups are gearing up for another fight with the US Centers for Medicare and Medicaid Services (CMS) over the agency’s previous decision not to cover drugs in its class unless patients are enrolled in clinical trials. If nothing changes, many patients would have to pay the full list price of $26,500 for one year of treatment.

According to Politico, “The Alzheimer’s Association, the powerful advocacy group, is in the process of a full-court press to meet with every lawmaker in the House and Senate, urging them to pressure CMS to change its decision, while a host of smaller advocacy groups argue against the drug’s widespread distribution because trial data show that its modest benefits for early-stage patients don’t outweigh the risks of severe side effects.”

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(Source: Politico Pulse, January 18^th, 2023)