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Massachusetts’ largest health insurer won’t cover new Alzheimer’s drug Aduhelm

Target 12

Biogen via AP

PROVIDENCE, R.I. (WPRI) – Blue Cross Blue Shield of Massachusetts announced Thursday it will not provide broad coverage of the new Alzheimer’s drug Aduhelm, calling it “investigational.”

In an email Amy McHugh, a spokesperson for BCBSMA – Massachusetts’ largest private health insurer – said members or physicians “can request individual consideration if they feel they may be a candidate for Aduhelm.”

“The clinical evidence for Aduhelm, though promising, does not clearly demonstrate that the potential benefits of the drug outweigh the known risks,” McHugh wrote.

This BCBSMA announcement follows Point32Health, the second biggest private health insurer in Massachusetts, which told Target 12 in August that it won’t cover the drug, calling it “experimental and investigational.”

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.

Patients in Rhode Island are already receiving the new Alzheimer’s drug. But experts have questioned the medication’s efficacy and as a result some insurance companies are choosing not to cover treatment.

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

In explaining its review process, BCBSMA states: “Our medical policy process includes a review of the clinical literature, discussion with specialists in the field and, for drugs, review through our independent pharmacy and therapeutics committee.”

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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