UnitedHealth Says Aduhelm Coverage Decision Will Hinge on Medicare Guidance

During the company’s July 15 call to discuss second-quarter 2021 financial results, UnitedHealth Group executives — perhaps unsurprisingly — fielded a question about how the company is approaching Aduhelm (aducanumab), the pricey new Alzheimer’s disease therapy that continues to be shrouded in controversy.

Chief Medical Officer Richard Migliori, M.D., told analysts that “we are continuing to develop our clinical policy as well as our ultimate position on coverage, but in doing so we’re looking forward to getting the guidance that we need from Medicare.” CMS on July 12 said it was opening a National Coverage Determination analysis on Aduhelm, which will ultimately specify how Medicare will cover the $56,000 per year treatment. In the meantime, coverage will be determined at a local level by Medicare Administrative Contractors, the Biden administration said.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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