Some private insurers are balking at paying for the first drug fully approved to slow mental decline in Alzheimer’s patients.
Blue Cross and Blue Shield of North Carolina, which has about 1.8 million commercial customers; and Philadelphia-based Independence Blue Cross.
“That re-evaluation made it clear to us that the existing evidence does not allow for conclusions to be drawn about the safety and effectiveness of Leqembi,” said Dr. Heidi Syropoulos, a medical director with the insurer. Because Medicare covers the drug, patients with privately run Medicare Advantage plans will receive coverage, said Juliette Cubanski, of the non-profit KFF, which researches health care issues.Most insurers will probably cover the drug but heavily restrict its use through things like requiring pre-approval, said Greg Warren, a health actuary and member of the Society of Actuaries.
Chambers said they have found that the decision to not cover a drug largely happens when the evidence supporting the drug is considered questionable. Eli Lilly and Co. said Wednesday its experimental Alzheimer's drug appeared to slow worsening of the mind-robbing disease in a large study. NBC 5's Bianca Castro talked with Frisco neurologist Dr. Aimee Garza about how it works.“It’s going to be a harder-to-justify decision for them if they know that Medicare has made a decision to cover it,” he said.
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