Will Medicare Cover New Alzheimer’s Drugs?

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A new Alzheimer’s prescription may soon be covered by insurance.

Alzheimer’s affects many people.

Those with the illness experience changes in memory, personality, and temperament.

Family and friends of those with the disease must watch their loved one slowly slip away.

Ongoing research continues regarding the prevention and treatment of the disease.

According to a recent CMS.gov article titled “CMS announces new details of plan to cover new Alzheimer’s drugs,” treatments for Alzheimer’s must meet specific requirements outlined by the Centers for Medicare & Medicaid Services (CMS) to qualify for Medicare coverage.

Alzheimer’s drugs have strict requirements for Medicare coverage.
FDA approval is just the first step in new Alzheimer’s drugs being covered by Medicare.

First, the prescription must be granted approval from the Food and Drug Administration (FDA).

For Medicare to cover the drug, the prescription must be administered in a setting where data and information can be gathered for the effectiveness of its use.

As a result, clinicians and physician teams must participate in a registry.

A registry involves the team collecting evidence about how the drugs work in the real world.

The CMS has facilitated a portal for physicians and clinicians to submit the required information.

Once a drug has been granted traditional approval, the user-friendly portal will be opened for information collection.

The CMS touts the “robust privacy protection” and HIPAA compliance of the portal.

Both researchers and the CMS will be able to access and use the information for conducting additional studies on these prescriptions.

The CMS issued a National Coverage Determination (NCD) on April 7, 2022.

This statement outlined how individuals must meet three requirements for Medicare coverage of an Alzheimer’s drug.

First, the individuals must be enrolled in Medicare.

Second, the individuals must be diagnosed with either mild Alzheimer’s disease or mild cognitive impairment.

Third, the prescribing physician must participate in the registry, have an appropriate clinical team, and provide follow-up care.

Several organizations are currently working with the CMS to prepare and open their registries.

Reference: CMS.gov (June 22, 2023) “CMS announces new details of plan to cover new Alzheimer’s drugs”

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