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

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.