Medicare Decision On Aduhelm Looms, Triggering Worries Over Funding
Stat reports on worries over Medicare's upcoming ruling over cover for controversial Alzheimer's drug Aduhelm, and if it will impact state Medicaid funding. The Biden administration's plan to empower pharmacies by cutting middlemen fees is also in the news, along with its impact on Medicare costs.
CMS Decision On Aduhelm Could Shock State Medicaid Programs
Shortly after the controversial Biogen drug for Alzheimer’s was approved in the U.S. last year, a pair of state Medicaid directors tried to ring alarm bells. In a terse letter, they implored the Biden administration to ensure Medicare covers the medicine, despite limited effectiveness and a $56,000 price tag. Their reasoning was simple: If Medicare reacted to the highly questionable approval by withholding or restricting coverage, Medicaid would be left holding the proverbial bag, because by law it must cover drugs endorsed by the Food and Drug Administration. And if that happened, they warned, Medicaid would have a big money problem. (Silverman, 1/10)
Biogen's Aduhelm Faces A Key Coverage Decision Next Week. Which Way Will Medicare Rule, And How Much Does It Matter?
Amid its sputtering launch, Biogen expects to receive a draft decision on Aduhelm’s coverage on Medicare next week. Industry watchers have been calculating a range of potential scenarios, but whichever direction the ruling goes, doctor feedback suggests it may simply not matter that much. A reimbursement decision on Aduhelm in Alzheimer’s disease from the Centers for Medicare and Medicaid Services (CMS) could go five different ways, with one that appears to be the most probable, a Jefferies team led by analyst Michael Yee wrote in a note this week. The government agency is due to deliver a preliminary decision on whether to cover the drug for elderly people by Jan. 12, with a final verdict scheduled for April. (Liu, 1/6)
In other pharmaceutical industry news —
Biden Administration Poised To Give Pharmacies A Major Lobbying Win
The Biden administration wants to rein in fees charged in Medicare by controversial middlemen that play a crucial behind-the-scenes role in the pharmaceutical pricing system. It would be a huge win for pharmacies, which have been lobbying in Washington for the change for years. The proposal would also lower out-of-pocket costs for some Medicare patients, but not all, as plans would likely raise premiums to compensate. The Centers for Medicare and Medicaid Services said the agency expects “more than half” of traditional Medicare patients would see lower total costs. (Cohrs and Silverman, 1/7)
Bayer To Pay Mammoth Biosciences $40 Million For Gene Editing Research
Bayer, the German pharmaceutical and agriculture firm, will pay California-based Mammoth Biosciences, a CRISPR-focused startup cofounded by Nobel laureate Jennifer Doudna, $40 million to work on gene-editing technologies in four different diseases, the firms said Monday. The companies said Bayer could eventually pay Mammoth milestones in excess of $1 billion if the projects pan out. Mammoth could receive royalties of up to a low double-digit percentage of sales on marketed products. (Herper and Molteni, 1/10)
The Drive To Digital In Pharma Marketing Is 'Overwhelming' Doctors
Pharma marketers don’t understand what healthcare professionals need—and, worse, they're overwhelming doctors with drug promos at the expense of more tailored content. This is according to a new report, the Digitally Savvy HCP, out from healthcare solutions company Indegene, which has been tracking these relationships for the past few years. This report focuses on just under 1,000 physicians from the U.S., Europe, India and China. It makes for some grim reading for pharma sales folks: 70% of healthcare professionals (HCPs) surveyed by the company feel that reps “do not completely understand their needs and expectations,” while 62% of HCPs are “overwhelmed” by product-related promotional content they receive from drugmakers. (Adams, 1/10)