UnitedHealthcare will limit coverage of Biogen’s Aduhelm, the nation’s major health insurance business notified providers Sunday.
The UnitedHealth Team subsidiary will only address the expensive Alzheimer’s disease treatment also recognized as aducanumab for sufferers enrolled in scientific trials and will demand prior authorization. The medication is “unproven and not medically necessary for the therapy of Alzheimer’s disorder thanks to inadequate proof of efficacy,” the insurance company wrote in bulletins despatched to providers.
The regulations implement to the insurer’s business, unique and Medicare customers and just take effect June 1.
The firm’s plan aligns with the Centers for Medicare and Medicaid Services’s latest determination to restrict Aduhelm protection to Medicare beneficiaries participating in clinical trials. Underneath federal regulation, Medicaid should cover almost all prescription medication that the Foodstuff and Drug Administration approves, including Aduhelm. States may well impose limitations this sort of as necessitating prior authorization, CMS determined.
UnitedHealthcare cited a selection of studies to help its determination, together with a July report by the Institute for Scientific and Financial Overview that concluded client use of the drug with supportive treatment did not make a net well being advantage as opposed to supportive treatment on your own.
“We will go on to monitor ongoing medical scientific tests, as nicely as assistance from CMS and other businesses, and will update our scientific and coverage procedures as needed,” UnitedHealthcare mentioned in a assertion.
UnitedHealthcare is the very first publicly traded wellness insurer to announce an Aduhelm coverage final decision. Other carriers, including at least 6 not-for-gain Blue Cross and Blue Defend affiliate marketers, are not covering Aduhelm. In addition, major providers these types of as Mount Sinai Wellness Technique and the Cleveland Clinic will not likely prescribe the drugs.
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