The position that UnitedHealth, a business that includes the largest private payer in the US, takes on coverage of Aduhelm will be important to the prospects of the controversial medicine.
With Biogen pricing Aduhelm at $56,000 a year, and Alzheimer’s being a large, unmet medical need, the therapy could add billions of dollars to healthcare spending. UnitedHealth wants to know more before making any commitments about the drug—and that means Biogen will need to wait to learn if the payer will provide access.
“I think this has some way to go before we get to real clarity, so I wouldn’t guide you to expect very rapid decision making on this piece. It’s really important to have a real clear understanding of how they should be used, what their value is in utilization,” said UnitedHealth CEO Andrew Witty on a July 15 conference call with investors.
Richard Migliori, chief medical officer at UnitedHealth, added that the company is continuing to work on its clinical policy and ultimate position on coverage. UnitedHealth is drawing on evidence from a range of sources as it develops its position.
As well as seeking advice from Alzheimer’s experts, professional bodies and physicians, UnitedHealth is continuing to assess data coming out of Aduhelm clinical trials and waiting on the guidance from Medicare.
Monoclonal antibodies targeting amyloid to treat Alzheimer’s
The US Centers for Medicare and Medicaid Services began its Aduhelm process in July with a call for comments on whether it should establish a national policy for monoclonal antibodies targeting amyloid to treat Alzheimer’s. CMS also held two public listening sessions to gather comments from the public.
While CMS is deciding whether to establish a national policy, Medicare Administrative Contractors that represent 12 jurisdictions across the US are formulating local coverage determinations. CMS expects to reach a final decision within nine months.
UnitedHealth shared the update on its thinking about Aduhelm on a call that also addressed the level of interest in biosimilars. Heather Cianfrocco, the CEO of UnitedHealth’s pharmacy benefit manager OptumRx, said her business is being shaped by the desire of clients to lower spending on specialty medicines.
“We’re finding that our site of care services for alternative sites and alternative therapies, like biosimilars, together with some of our specialty programs that work through OptumHealth and OptumRx and straddle the medical and pharmacy benefit, are really resonating,” said Cianfrocco.