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Blue Cross RI won’t cover new Alzheimer’s drug Aduhelm

Health

PROVIDENCE, R.I. (WPRI) – Blue Cross Blue Shield of Rhode Island announced late Thursday it will not provide coverage of the new Alzheimer’s drug Aduhelm.

In an email Jill Flaxington, a spokesperson for BCBSRI – Rhode Island’s largest private health insurer – said the company awaits a decision from Centers for Medicare & Medicaid Services regarding Medicare coverage.

“After review by a local, independent panel of healthcare providers to assess the health and safety of [Aduhelm], Blue Cross & Blue Shield of Rhode Island has designated [Aduhelm] non-covered based on an evaluation of safety and clinical efficacy for non-Medicare members,” Flaxington wrote.

As of Aug. 3, four patients at Butler Hospital in Providence were receiving monthly infusions of Aduhelm, with more than 100 patients on the waiting list, according to Dr. Stephen Salloway, the director of the Butler Hospital Memory and Aging Program.

On Friday, Salloway did not say how many patients are receiving the drug currently.

When asked by Target 12 what the next steps are for those with Blue Cross coverage, he said: “Butler Hospital does not comment on any independent health insurer’s coverage decisions and/or policies. Moving forward, we continue to work with carriers to ensure coverage for patients who may benefit from the Alzheimer’s drug, Aduhelm.”

On June 7, the Food and Drug Administration approved the use of Aduhelm, the first new Alzheimer’s drug in nearly 20 years, despite not a single member from the 11-person FDA advisory committee voting in favor.

In the wake of the FDA’s decision, three of the 11 committee members resigned over the FDA’s decision to approve Aduhelm.

The drug, created by the Cambridge-based company Biogen, is intended to slow the cognitive decline in Alzheimer’s patients in the early stages of the disease. Approximately six million Americans are affected by Alzheimer’s disease, including roughly 24,000 Rhode Islanders, according to the R.I. Department of Health.

Blue Cross Blue Shield affiliates in Massachusetts, North Carolina, Pennsylvania, Michigan, New York and Kansas have indicated they won’t cover treatment at this time.

In explaining its review process, BCBSRI states: “BCBSRI will evaluate our coverage decisions as more clinical data becomes available to determine whether [Aduhelm] achieves clearly demonstrated clinical benefit and safety.”

Tolly Taylor (ttaylor@wpri.com) is a Target 12 investigative reporter for WPRI 12. Connect with him on Twitter and on Facebook

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