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U.S. starts national Medicare coverage policy review for Biogen's Aduhelm

Published 07/12/2021, 05:32 PM
Updated 07/12/2021, 06:11 PM
© Reuters. FILE PHOTO: A sign marks a Biogen facility in Cambridge, Massachusetts, U.S. January 26, 2017. REUTERS/Brian Snyder/File Photo

(Reuters) -The U.S. government on Monday started a review process for national Medicare coverage of Biogen Inc (NASDAQ:BIIB)'s Alzheimer's drug, Aduhelm, that was recently approved by the country's health regulator.

The Centers for Medicare & Medicaid Services (CMS) expects to give a proposed decision within 6 months and a final decision within 9 months. (https://go.cms.gov/3hzMa6H)

Aduhelm is priced at $56,000 per year, which could represent significant spending for the government's Medicare program for people aged 65 and older.

© Reuters. FILE PHOTO: A sign marks a Biogen facility in Cambridge, Massachusetts, U.S. January 26, 2017. REUTERS/Brian Snyder/File Photo

Currently, coverage for the drug is determined at the local level by Medicare administrative contractors, who represent 12 jurisdictions across the country.

CMS' coverage decisions are based on an analysis of the benefits of a given therapy to Medicare beneficiaries.

Latest comments

Martin, probably "marginal" costs would be a better way to apply to any situation, but do you know the cost to live in a community. Otherwise next time they're is a war, a fire, any emergency we can call you or any other. minions that are only looking one side of the solution.
I already pay over 30% of my income to this massively inefficient government bureaucracy. I have friends, family, and personal experience with healthcare in other countries. No need to preach to me. Name one socialistic country or country with universal healthcare where you think their healthcare is better than that of the US. As mentioned, there are already a massive number of government programs to help low income individuals, of which my tax is going to pay for already. You do not need universal healthcare to provide healthcare to individuals in poverty. Universal healthcare is simply a talking point of socialists/communists to make people dependent on the government, which only gets money through taxing its citizens. Here are some other socialist countries throughout history: China, North Korea, Soviet Union, Nazi Germany (Hit.t.ler was a democratic socialist), and Cuba (which is currently burning itself down rioting like blue cities across the US).
And note, when I said "better than that of the US" I am also referring to quality of care, not just quantity. You are not going to get first-world treatments using third-world economic models. The innovation and capacity to provide healthcare in the US is due to privatized healthcare. US emergency departments cannot turn away people without insurance, and every state has programs to provide healthcare for low-income individuals. It is cognitive dissonance to say the current free government healthcare programs are bad, so we need to nationalize those programs to everybody in the country and not give them  choice.
And for those who do not understand how tax works, when the government adds an extra $1000-2000/year or more to your income tax to pay for universal healthcare then you will understand the true cost. It is like social security program....imagine if you could have saved/invested that chunk of your paycheck rather than give it to the government who has not even been able to sustain the program. Do you think most people get back from social security more than they paid in? These programs just penalize responsible people for people who are financially irresponsible...there are already social programs to help people with low incomes.
And for those who do not understand how tax works, when the government adds an extra $1000-2000/year or more to your income tax to pay for universal healthcare then you will understand the true cost. It is like social security program....imagine if you could have saved/invested that chunk of your paycheck rather than give it to the government who has not even been able to sustain the program. Do you think most people get back from social security more than they paid in? These programs just penalize responsible people for people who are financially irresponsible...there are already social programs to help people with low incomes.
Leftists love running around saying "free universal healthcare!", but what they do not tell you is the government chooses what procedures/medications/etc are covered. Universal healthcare, everywhere it has been done, has lead to two-tier healthcare...public and private. Public has limited access, limited coverage and private is where the upper classes of society gets their care. All this does is brings third world healthcare to a first world country. In the US, people in poverty already have programs like Medicaid to provide coverage. Putting the government in charge of everybody's healthcare is  great way to reduce quality of care for everybody except those who can pay private healthcare costs. For reference, India's hospital system has been socialized and their system almost collapsed recently.
"Universal healthcare,..., has lead to two-tier healthcare...public and private.." E.g., BRAZIL. Here, we have both systems, but during this pandemics some people kept repeating ad nauseam "Thanks God we have a universal, public, 'free' system!!!!" What they purposely "forget" to say is that Brazil has one of the highest ratios of ICU beds per 100k citizens in the world (maybe second only to US!), which is being simply PARAMOUNT to fight COVID-19... ...but 3/4 of this capacity...is in the PRIVATE sector!!! Now imagine the global scenario we had in the first months of the pandemics: the huge shortage of medical equipment and supplies, prices skyrocketing, countries cutting the line to get what they desperately needed. Any government could have a TRAIN FULL OF GOLD and even then could never be able to build alll those beds in a short time. It was the PRIVATE enterprise which built all that capacity that has been readily used in this pandemics, even..ironically...contracted by the public sector.
 Exactly, and it is not like governments cannot mobilize resources during emergencies. The US does not have universal healthcare, but the government spent massive amounts of money paying for anything related to COVID-19 (even for people who did not need it)...but as you pointed out, this infrastructure was largely built by private industry. Socialist systems are already strained even without emergency situations.
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