Private Medicare required to cover Biogen’s ALS drug by US Agency

Private insurers are now required to cover Biogen’s ALS FDA approved drug, Qalsody, by the Centers for Medicare & Medicaid Services (CMS) following reports of coverage denials.

Previously, Medicare Advantage plans, which covers adults 65 years and older or those with disabilities, were denied coverage under the pretense of the drug being “experimental and investigational.” This policy change expands access to critical care for those living with ALS.

“We expect MA plans to expeditiously contact enrollees that were inappropriately denied coverage of Qalsody based on its classification as experimental and investigational to inform them that coverage policies for Qalsody have changed,” said CMS in their press release.