Washington, D.C.-based healthcare consulting firm Avalere Health studied the potential effect of a draft Medicare plan that could prohibit patient access to new monoclonal antibody Alzheimer's disease treatments.
The March 11 analysis says CMS issued a draft national coverage plan in January that explains the specific conditions of when Medicare may cover the Alzheimer's drug Aduhelm and future monoclonal antibody treatments that fight amyloid plaque.
The draft plan would only cover the treatments within the context of CMS-approved or National Institutes of Health-supported randomized controlled trials. The plan states that those trials could only be conducted in hospital outpatient departments and most likely would include Alzheimer's disease research departments. It's unclear how many hospitals would actually conduct those trials.
Avalere's analysis says that part of the problem is that 7 percent of all fee-for-service Medicare beneficiaries with early-onset Alzheimer's or mild cognitive impairment do not live in a county with a hospital outpatient department. Among rural fee-for-service enrollees, 31 percent do not have access to a hospital outpatient department.
Alzheimer's disease research centers are generally highly concentrated across the country, with only 26 states reporting having at least one. There are 33 total ADRCs and four exploratory ones nationwide.
Avalere's analysis says the other potential issue with patient access is that only 21 percent of all fee-for-service Medicare beneficiaries with early-onset Alzheimer's or mild cognitive impairment have an Alzheimer's research center in the county they live in and 79 percent do not. Fewer than 1 percent of rural fee-for-service enrollees with the same diagnoses have a research center in their county.
CMS is expected to issue a decision on the draft plan by April 11. Until then, local Medicare contractors will determine coverage for monoclonal antibody treatments for Alzheimer's on a case-by-case basis.