The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare will cover drugs designed to slow Alzheimer’s disease once they receive traditional approval by the US Food and Drug Administration (FDA).
The one caveat is that CMS will require physicians to participate in registries that collect evidence about how these drugs work in the real world.
Physicians will be able to submit this evidence through a nationwide, CMS-facilitated portal that will be available when any product gains traditional approval and will collect information via an easy-to-use format.
“If the FDA grants traditional approval, then Medicare will cover it in appropriate settings that also support the collection of real-world information to study the usefulness of these drugs for people with Medicare,” the CMS says in a news release.
“CMS has always been committed to helping people obtain timely access to innovative treatments that meaningfully improve care and outcomes for this disease,” adds CMS Administrator Chiquita Brooks-LaSure.
“If the FDA grants traditional approval, CMS is prepared to ensure anyone with Medicare Part B who meets the criteria is covered,” Brooks-LaSure explains.
The CMS says broader Medicare coverage for an Alzheimer’s drug would begin on the same day the FDA grants traditional approval. Under CMS’ current coverage policy, if the FDA grants traditional approval to other drugs in this class, they would also be eligible for broader coverage.
Currently two drugs in this class — aducanumab (Aduhelm) and lecanemab (Leqembi) — have received accelerated approval from the FDA, but no product has received traditional approval.
Lecanemab might be the first to cross the line.
On June 9, the FDA Peripheral and Central Nervous System Drugs Advisory Committee will discuss results of a confirmatory trial of lecanemab, with a potential decision on traditional approval expected shortly thereafter.
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