Current Market Access to Alzheimer’s Disease Medications

The FDA on June 7 approved Biogen Inc.’s Aduhelm (aducanumab) to treat Alzheimer’s disease, the first novel therapy approved in this indication since 2003. The accelerated approval of Aduhelm was controversial as results of two Phase III trials in patients with early-stage and mild Alzheimer’s contradicted each other. There are a host of other Alzheimer’s medications on the market, all of which are covered under the pharmacy benefit. The majority of insured people under commercial and Medicaid formularies have plans that put Alzheimer’s drugs under the preferred/preferred (prior authorization and/or step therapy) tier and covered/covered (PA/ST) tiers. More than half of payer pharmacy benefit formularies do not require step therapy or prior authorization for Alzheimer’s medications.

NOTE: Under the pharmacy benefit, the total covered lives under commercial, health exchange, Medicare and Medicaid formularies are 170.0 million, 11.7 million, 47.8 million and 69.8 million, respectively.

SOURCE: Managed Markets Insight & Technology, LLC database as of June 2021.

Jinghong Chen Reporter

Jinghong produces infographics and data stories on health insurance and specialty pharmacy for AIS Health. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting. Before joining AIS in 2018, she worked at WBEZ, Al Jazeera English and The New York Times Chinese.

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