Blues plans pass on including aducanumab on formulary

Biogen
Here's a roundup of key coverage decisions on Aduhelm from across healthcare. (Biogen)

Several Blues plans have decided they will not cover Biogen's controversial Alzheimer's disease drug Aduhelm as the industry weighs the pros and cons of what is set to be a costly but in-demand therapy.

New York-based Excellus BlueCross BlueShield announced late last week that it will not cover the treatment due to concerns over its efficacy, Syracuse.com reported.

The drug "has not been medically proven to be effective and, therefore, is considered investigational for the treatment of Alzheimer’s disease," the insurer said in a statement.

Six other Blues insurers have also decided they will not cover Aduhelm at all. Others, such as Highmark, said they will cover it only with prior authorization.

RELATED: Industry Voices—For payers, determining Aduhelm coverage is a waiting game

Some large providers have reportedly also declined to cover the therapy, including Cleveland Clinic and Mount Sinai.

As more payers and providers consider next steps related to Aduhelm—and the industry awaits the Centers for Medicare & Medicaid Services' national coverage determination—here's a roundup of key coverage decisions on Aduhelm from across healthcare.


Department of Veterans Affairs won't include Aduhelm on formulary

The Department of Veterans Affairs (VA) will not include aducanumab on its formulary, the agency announced, due to a "risk of significant adverse drug events" and a lack of evidence on its clinical efficacy.

Sales representatives will also not be able to promote the drug to VA doctors, according to internal documents.

The agency also launched a list of requirements before a VA patient can be prescribed Aduhelm.

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