, Aduhelm, made by drugmaker Biogen, is meant to slow the progression of Alzheimer's by removing a sticky plaque that builds up in the brains of some people with the disease. It's not clear if it improves memory or cognition in patients.threaten to strain both the finances of patients and Medicare
Some experts say the price tags of Aduhelm and a pipeline of future high-cost treatments should encourage the federal government and private insurers to find new ways to pay for drugs, including arrangements in which payment is based on whether they work or not. Health insurers like Cigna and Humana are already thinking about entering into such"value-based" contracts.
Meanwhile, Humana CEO Bruce Broussard said during the company's investor day on Tuesday that while Humana hasn't yet had any detailed conversations about an outcomes-based contract for Aduhelm, it hopes to strike one up. Analysts at Capital Alpha Partners said in a research note June 8 that contracts based on patients' health outcomes are difficult to work out administratively, but Aduhelm's high-cost and potentially large patient demand could prompt the Centers for Medicare and Medicaid Services to propose one for the drug.
"It is just a question of getting enough new drugs that challenge our existing payment model," Lakdawalla said."Those have been the exception rather than the rule, but I think we're moving into an era when they will increasingly become more prevalent."
spoiler alert: they'll raise premiums and deductibles along with new exclusions to not pay claims