CMS Proposes Coverage Of Biogen's Alzheimer's Drug, With Conditions Apply

The Centers for Medicare & Medicaid Services (CMS) released a proposed national coverage determination for Medicare to cover drugs that target amyloid for mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia. 

• However, the decision only extends to patients in a qualifying clinical trial.
• The U.S. Centers for Medicare and Medicaid Services (CMS) decision could change as it seeks comment from companies and patients. A final decision is due on April 11.
• The final CMS coverage terms are expected to apply to all drugs in the class, including experimental medications by Eli Lilly And Co LLY, Roche Holding AG RHHBY, and approved treatment from Biogen Inc BIIB and Eisai Co Ltd ESALY.
• Patient advocacy group, UsAgainstAlzheimer's Chairman George Vradenburg, said he was angry Medicare placed conditions on the use of the drugs that were more limiting than the regulator put on Aduhelm and that the Medicare decision applied to any amyloid drug.
• CMS's demand for more evidence before it will pay for Aduhelm, priced at $28,200 a year, comes six months after the FDA granted the drug an accelerated approval. 
• Price Action: BIIB shares are down 9.95% at $217.50 during the premarket session on the last check Wednesday.