Excellus BlueCross BlueShield says it will not cover Aduhelm, a controversial new Alzheimer’s drug, because there’s not enough evidence it works.The health insurer said in a policy statement Aduhelm ” … has not been medically proven to be effective and, therefore, is considered investigational for the treatment of Alzheimer’s disease.”
- Efficacy: Excellus is Central New York’s largest health insurer. At least six other Blues health plans, including BlueCross BlueShield of Western New York, have declined to cover the medicine, which is projected to cost $56,000 per patient per year. The US Veterans Health Administration also said that it will not fund Aduhelm due to concerns about its efficacy and safety.
- Effective: “Our health plan wants our members to have access to therapies that are safe, effective, and evidence-based as demonstrated by peer-reviewed clinical trials,” said Elizabeth Martin, an Excellus vice president.
- Progressive: The FDA authorized the treatment on June 7 despite the fact that an outside panel of specialists indicated there wasn’t enough evidence that Biogen’s drug reduced disease progression. It’s the first new treatment for incurable brain disease in two decades. Alzheimer’s disease affects 6.2 million people in the United States, including 410,000 people in New York.
- Insurance: Because of uncertainties regarding insurance coverage and questions about the FDA’s clearance process, Upstate University Hospital in Syracuse, which handles more than 3,000 Alzheimer’s patients each year has yet to determine whether or not to administer the treatment. The Cleveland Clinic in Ohio and Mount Sinai in New York City, for example, has decided not to give the medicine.
- Investigation: The FDA’s interim commissioner recently ordered an independent investigation of the agency’s approval of the drug after news stories reported the FDA and Biogen officials developed a cozy relationship before the drug’s approval. A Democratic congresswoman from California charged Biogen with having “undue influence” over the approval process.