After years of advancements by the Alzheimer’s association and other foundations that help fight Alzheimer’s disease and dementia, the Centers for Medicare and Medicaid Services (CMS) finally drafted and submitted a plan to cover new Alzheimer’s medications. Though the changes are a step towards the right direction, the plan requires many obstacles and makes it difficult for people to acquire the coverage they need to get these life-changing prescriptions.
Medicare will only cover medications under Medicare Part B for drugs with traditional FDA approval such that the physician and clinical team participates in a registry to collect evidence and research. Though the CMS suggests the information acquired through these studies will potentially help people; the Alzheimer’s association and other affiliated support groups think otherwise. The Alzheimer’s association criticized the mandatory use of the registry, and suggests it is “an unnecessary barrier” for people to receive medication that have already gone through the stages of FDA-approval. The pharmaceutical trade group PhRMA (Pharmaceutical Research and Manufacturers of America), also opposes the CMS’s requirements of the registry, and suggests “CMS is reaffirming their plan to severely restrict patient access.” Some of these restrictions may occur if the patient does not choose to participate in the registry, or if their doctor is not enrolled in the program.
Alzheimer’s disease is a fatal disease with no known cure, and an estimated 6 million people suffer from it. As the most common form of dementia, it is of utmost importance to allow coverage for the treatment to be uncomplicated. Unfortunately, this is not the first time CMS has received backlash for their narrow and controversial proposals. Despite the CMS reporting on the inconveniences and the problems underrepresented communities face in participation in clinical trials, in December, the CMS ruled they would only cover Alzheimer’s medication if the Medicare recipient is enrolled in a clinical trial. Medicare has always covered FDA-approved treatments, for long-term health condition ie; cancer, heart disease, or HIV/AIDs regardless of their approval pathway, and CMS should treat Alzheimer’s in a similar manner to avoid being unprecedented.
Overall, the decision from the CMS was an important one, but there are crucial changes to be made. With the current approach, access to ground-breaking medications will only be available to a select privileged group of people causing more healthcare disparities and inequities. By changing the stipulations for coverage, the medications will reach the target audience faster and more efficiently to slow the progression of Alzheimer’s disease. To truly put an end to Alzheimer’s disease and all other dementia, the CMS must be willing to maximize quality care and support by allowing coverage of the new medications.
Article Link: https://www.cms.gov/newsroom/fact-sheets/cms-announces-new-details-plan-cover-new-alzheimers-drugs