Ever since the United States Food and Drug Administration (FDA) approved aducanumab and Centers for Medicare & Medicaid Service (CMS) restricted coverage for the drug, a crucial question has been how other payers will behave. This study examined how Medicaid and commercial plans cover aducanumab.
We created a database of aducanumab coverage policies issued by Medicaid fee-for-service programs (50 states and DC) and 35 of the largest commercial plans (covering ∼ 84% of the commercially insured population).
We found that only 41% of Medicaid fee-for-service plans have issued a publicly available coverage policy for aducanumab and that there is wide variation in these coverage criteria. Although the majority of included commercial plans have issued an aducanumab coverage policy, only five plans covered aducanumab for their enrollees. Available coverage polices showed little consistency in how to measure sufficient treatment response.
Differences in coverage policies mean that Alzheimer's patients’ access to aducanumab may vary across jurisdictions and across commercial insurers.
- Less than half of state Medicaid fee-for-service plans issued a publicly available coverage policy for aducanumab.
- Available Medicaid coverage policies varied substantially in their coverage criteria.
- The majority of included commercial plans issued an aducanumab coverage policy; only five plans covered aducanumab.
- Available coverage polices showed little consistency in how to measure sufficient treatment response.