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.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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