News Briefs

Sens. Bill Cassidy, M.D. (R-La.) and Bob Menendez (D-N.J.) on July 14 introduced legislation seeking to redesign the Medicare Part D benefit structure and limit seniors’ out-of-pocket (OOP) drug costs. The bipartisan Seniors Prescription Drug Relief Act would establish an OOP cap on catastrophic coverage, so that seniors would pay no more than $3,100 in OOP spending, and restructure Part D to “realign these flawed incentives and lower the cost of prescription drugs.”

CMS this month began a National Coverage Determination (NCD) process for the newly approved Alzheimer’s treatment Aduhelm (adacanumab). That analysis, which will create Medicare coverage standards on a national level, will apply to Aduhelm “as well as any future monoclonal antibodies that target amyloid for the treatment of Alzheimer’s disease,” CMS stated. The July 12 start of the NCD process also kicked off a 30-day public comment period; CMS will also host two public listening sessions this month. The FDA last month approved the $56,000-a-year infused drug, despite questions about its clinical efficacy. CMS will first issue a proposed NCD, which will be subject to a second 30-day comment period and is expected within six months, with a final decision posted within nine months. Until then, coverage decisions will be made at the local level by Medicare Administrative Contractors, according to the announcement.

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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