CMS Rules Require State Medicaid Plans To Cover Aduhelm Treatment For Alzheimer’s Disease

State Medicaid programs must cover Aduhelm, a new medication manufactured by Biogen, Inc. and Eisai Inc. to treat early-stage Alzheimer’s disease. Biogen participates in the Medicaid Drug Rebate Program (MDRP), which means that Aduhelm is a covered outpatient drug. Under the MDRP, state Medicaid programs are permitted develop medical necessity criteria for covered outpatient drugs, including Aduhelm.

Biogen has set a wholesale price point of about $56,000 per year for Aduhelm. The medication is an infusion administered every four weeks, at a cost of about $4,312 per infusion (for a person weighing about 160 pounds). The . . .