Biogen offers free Alzheimer’s drugs, as uncertainty in Medicare payment remains

August 30 (Reuters) – Biogen Inc. (BIIB.O) supplies its controversial and expensive Alzheimer’s drug for free to some patients amid slow Medicare reviews, according to sources familiar with the situation, including a doctor treating patients with drugs.

The development underscores the divide among doctors over whether the $ 56,000-a-year drug helps patients and how uncertainty about Medicare reimbursement, the U.S. government’s health plan for people over 65, has slowing down recipes and sales.

Aduhelm, which is given as a monthly infusion, was approved by the U.S. Food and Drug Administration in June, although one of Biogen’s two major clinical trials showed no benefit to patients diagnosed with the disease. incurable to waste the mind.

In order to expedite treatment, Biogen has begun providing Neurology First Choice of Florida Aduhelm free of charge, according to Dr. Jeffrey Gelblum, an operations neurologist at the Adventure Center, Florida.

“We used the Biogen access program (it’s almost like a sample program) to start patients,” he told Reuters.

Biogen has said it has a number of plans to support patient access, but has not given further details.

Pharmaceutical companies can provide drugs for free through patient care programs, “although we’ve never heard of this for an injectable, infused drug,” said Steven Lucio, vice president of Vizient Inc., who works with about half of U.S. hospitals to buy drugs. an email.

James Chambers, a researcher at the Center for Health Value and Risk Assessment at Boston’s Tufts Medical Center, said providing free drugs is a common strategy drug makers do to increase the number of patients ’prescriptions.

HOSPITALS They are used slowly

Several hospitals, as well as the Veterans Health Administration, have said there is not enough evidence to justify the widespread use of Aduhelm.

Several commercial insurers, including UnitedHealth Group Inc (UNH.N), the largest private insurer offering Medicare Advantage coverage to seniors, have said they wait for more Medicare instructions before covering the drug.

“Mainly because of the uncertainty about insurance coverage … most doctors and systems have a pattern of involvement,” Dr. also known as adducanumab, in patients enrolled in clinical trials.

A recent survey of 78 neurologists by Morgan Stanley found that half were willing to prescribe Aduhelm, but nearly two-thirds do not believe the FDA should have approved the drug. Only eight of the neurologists surveyed had prescribed Aduhelm and six of their Medicare claims had been paid in early August.

The Florida First Choice has so far infused more than 30 patients with Aduhelm, but only the first doses for two patients were billed to Medicare: their second doses and the first doses for the others were provided at no cost to Biogen, said Dr. Gelblum.

He said Medicare reimbursed the clinic for the claims infusion component, but not for the drug itself, though he expects that to happen in the coming weeks.

Because Alzheimer’s is an age-related disease, about 85% of people eligible for Aduhelm are covered by Medicare, which recently began a nine-month process to determine the terms of standardized national drug coverage.

At the moment, the government health plan is processing Aduhelm’s claims on a case-by-case basis.

In addition to the medication itself, Aduhelm’s administration costs include diagnostic testing for Alzheimer’s and monitoring for side effects such as dangerous brain inflammation.

Experts say Medicare could try to reduce the costs of therapy for taxpayers by limiting access to treatment, linking coverage to real-world evidence of patient outcomes, or establishing a fixed payment that combines drug reimbursement with others. treatment-related costs.

Aduhelm, developed in collaboration with the Japanese Eisai Co Ltd (4523.T), comes in two bottle sizes of 300 milligrams (mg) and 170 mg. Patients start with a low dose, which increases over time to the full dose of 10 mg per kg of patient weight.

Drug sales are projected to reach $ 81 million this year, $ 1.3 billion next year and $ 5.8 billion in 2026, according to Wall Street analysts surveyed by Refinitiv.

Deena Beasley Reports; edited by Caroline Humer and Jonathan Oatis

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