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CMS Treatment Coverage Policy: What It Means for People Living with Alzheimer’s

CMS Treatment Coverage Policy: What It Means for People Living with Alzheimer’s
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In April 2022, the Centers for Medicare & Medicaid Services (CMS) issued an unprecedented decision restricting Medicare coverage of FDA-approved treatments that target amyloid for Alzheimer's disease. This policy applies to all currently FDA-approved monoclonal antibody treatments, including lecanemab (Leqembi®) and aducanumab (Aduhelm®), and others that may receive approval. (Aducanumab will be discontinued on Nov. 1, 2024. Please connect with your provider on treatment options.)

Following extensive efforts by the Alzheimer's Association, bipartisan members of Congress, state attorneys general, clinicians and, most importantly, advocates from communities all across the country, CMS has updated its coverage plan for traditionally approved FDA treatments.
 

Barriers to treatment

The April 2022 CMS decision restricts Medicare coverage of FDA-approved medications for Alzheimer's disease that receive accelerated approval. This decision prevents people who could benefit from these treatments from receiving them even if their doctor prescribes them.

On Dec. 19, 2022, the Alzheimer's Association filed a formal request asking CMS to provide full and unrestricted coverage for FDA-approved Alzheimer's treatments. The Association is asking CMS to remove the requirements that Medicare recipients must be enrolled in a clinical trial in order to be eligible for these FDA-approved treatments.

Medicare has always covered FDA-approved treatments for those living with other conditions like cancer, heart disease and HIV/AIDS regardless of approval pathway. For CMS to treat those with Alzheimer's disease differently than those with other diseases is unprecedented and unacceptable.

Amplifying the voices of people living with dementia

If you're living with early-stage Alzheimer's or mild cognitive impairment (MCI), we need your voice. Share your story about what access to FDA-approved treatments means to you, and change the course of Alzheimer's.

Share Your Story

Listen to the real consequences of this decision for people living with Alzheimer’s.

More information

 

Navigating Treatment Options

Promising new treatments can help people living with Alzheimer's. It is important to learn as much as you can about which drugs are available.

 

Our Commitment to Transparency

The Alzheimer’s Association received just over 1% of its total 2022 contributed revenue from the biotechnology, pharmaceutical, diagnostics and clinical research industry.

 

Mild Cognitive Impairment (MCI)

Learn about mild cognitive impairment, an early stage of memory loss or other cognitive ability loss (such as language or visual/spatial perception).

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About the Alzheimer’s Association

The Alzheimer's Association leads the way to end Alzheimer's and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer's and all other dementia®.

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