“How Might the FDA’s Approval of a New Alzheimer’s Drug Impact Medicaid?”

“How Might the FDA’s Approval of a New Alzheimer’s Drug Impact Medicaid?,” by Rachel Dolan and Elizabeth Williams, Kaiser Family Foundation

Quote:

“The recent approval of Aduhelm (aducanumab), which treats Alzheimer’s disease and carries an expected annual price tag of $56,000, has brought increased attention to high-cost drugs approved through the FDA’s accelerated approval pathway. While Medicare and its beneficiaries likely will be most impacted by the costs of the drug, as Alzheimer’s disease is most prevalent among older adults, the drug approval also has implications for Medicaid spending. Medicaid covers more than 80 million people, including many older adults who have not yet reached the age of Medicare eligibility. Medicaid will see increased costs through direct payment of Aduhelm for individuals who receive their drug coverage through Medicaid, as well as through potentially higher Medicare premium payments and cost-sharing for dual eligible beneficiaries (people eligible for both Medicare and Medicaid). Recent policy proposals targeted to accelerated approval drugs, as well as states actions to address coverage issues for very high-cost drugs in Medicaid, may mitigate the cost impact for Aduhelm, but challenges remain in addressing the impact of very high-cost drugs coming to market. Despite rebates, Medicaid could face substantial costs for covering Aduhelm for enrollees who receive their prescription drug coverage through Medicaid.”

 

LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:

The rationing begins. Will no one have access to break-through drugs because Medicaid and Medicare cannot afford them? Will there even be more break-through drugs if pharma can’t make the profits to fund R&D? Will the FDA stop approving any new drugs that are too expensive? What a mess.