Medicare Coverage For Leqembi: Timeline For Reconsideration Of Restrictions
After getting a formal request for Medicare to reconsider coverage for Eisai’s new drug and other mAbs, CMS must decide by mid February whether to undertake the process. The formal timeline for reconsideration runs six to 12 months; past reviews have taken around nine months.
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Biogen will likely add sales reps to support Eisai’s US commercial launch of the Alzheimer’s drug early next year when treatment capacity increases.
Medicare coverage restrictions are more likely to be reconsidered on a case-by-case basis as drugs in the class obtain traditional US Food and Drug Administration approvals in the coming months.
Eisai has spent 25 years looking for a breakthrough in Alzheimer’s and warns that healthcare systems need to undergo a major shift to accommodate its breakthrough drug.