In 2021, they said yes. Then they said maybe. Now, Medicare has decided it will cover Alzheimer’s treatments for Medicare recipients who meet specific requirements.

 

In November 2021, the Centers for Medicare and Medicaid Services (CMS) announced the monthly Medicare Part B premium would go up for 14.5% to cover the high cost of the Alzheimer’s drug Aduhelm. Then, rather than make Aduhelm available to everyone, CMS said it would cover Aduhelm for Part B enrollees participating in a clinical trial for the drug.

 

Now, almost two years later, CMS has a new, more definitive policy to provide treatment for the 7.5 million retirees afflicted with Alzheimer’s. Medicare has decided that under certain circumstances, it will cover multiple drugs that may slow the progression of Alzheimer’s.

 

In a press release, CMS Administrator Chiquita Brooks-LaSure said, “Alzheimer’s disease takes a toll on not just the people suffering from the disease but also on their loved ones and caregivers in a way that almost no other illness does. CMS has always been committed to helping people obtain timely access to innovative treatments that meaningfully improve care and outcomes for this disease. If the FDA grants traditional approval, CMS is prepared to ensure anyone with Medicare Part B who meets the criteria is covered.”

 

To qualify for coverage, patients must be enrolled in Medicare Part B and have a diagnosis of mild cognitive impairment or early dementia caused by Alzheimer’s. CMS will require patients to participate in a registry, working with a qualified physician, to collect and submit data on how the drugs work. The information will be accessible for studies that attempt to further the understanding of the drugs.

 

The Food and Drug Administration (FDA) has granted accelerated approval to two drugs in the class, Aduhelm and Leqembi, but neither has received traditional approval which would make them eligible for broader Medicare coverage. A decision on traditional approval for Lecanemab is expected within a few weeks. The FDA’s Peripheral and Central Nervous System Drugs Advisory Committee will discuss results of a confirmatory trial on June 9. If Leqembi receives traditional approval, broader Medicare coverage would begin the same day.