Company discusses its strategy for negotiating a change in the recently-proposed Medicare coverage decision for Alzheimer’s drugs during a presentation to analysts.

Proposed Medicare national coverage policy would delay access to Alzheimer’s drugs for too long and the government should instead cover the drugs under specific conditions until research already underway comes in, Global Alzheimer’s Platform Foundation president John Dwyer argues.

Proposed decision withholds Medicare coverage from current and future amyloid-directed monoclonal antibody drugs for Alzheimer’s disease unless patients are enrolled in a randomized clinical trial.

Proposal reflects a concern that plans and pharmacy benefit managers are inappropriately benefitting from price concessions (in this case from pharmacies) while beneficiaries are not, a theme the pharma industry has been pushing for some time.

Commercial payer programs to undercut manufacturer cost sharing assistance for drugs may continue next year under proposed rule released by the Centers for Medicare and Medicaid Services.

Because Medicare and Medicaid do not reimburse based on indication, it would be hard to target specific accelerated approvals for pricing discounts. This could penalize drug manufacturers even if the accelerated indication represents a minor share of the drug’s use, researchers say.