CMS decision would limit Alzheimer’s care

Dr. Kenneth Pugar recently submitted this editorial to the Dayton Daily News on the CMS draft decision that effectively denies Medicare coverage of FDA-approved medications for Alzheimer’s disease unless the person is enrolled in an approved clinical trial

Dr. Kenneth Pugar

“The Centers for Medicare & Medicaid Services (CMS) draft decision handed down earlier this month is shocking discrimination against everyone with Alzheimer’s disease, especially those who are already disproportionately impacted by this fatal disease, including African Americans and Hispanics.

With this approach, access to treatment would now only be available to a privileged fewꟷthose with access to research institutions, or those who can afford to pay out-of-pocket and “skip the steps” imposed by this decision.

This proposed CMS coverage decision is so restrictive, it can hardly be considered coverage. It effectively denies access to all current and future FDA-approved treatments targeting amyloid in those living with Alzheimer’s disease — regardless of clinical trial results and what the FDA recommends.

In my opinion CMS has duty to ensure equitable access for all who could benefit from FDA-approved treatments, regardless of the disease for which it is intended. People living with Alzheimer’s disease deserve the same access to therapies given to those living with other conditions like cancer, heart disease and HIV/AIDS. For those in the Administration to treat those with Alzheimer’s disease differently than those with other diseases is discriminatory, prejudicial, and simply unacceptable.

As a member of the Alzheimer’s Association Miami Valley Chapter board and a Dayton neurologist for 32 years, I urge CMS to change this draft decision on behalf of my patients and all who are impacted with Alzheimer’s. The CMS decision has pulled the rug from under us concerning the treatment options for some of my current patients and patients in the future.

If you care for someone living with Alzheimer’s, are an individual living with the disease, or are concerned about dementia, speak out now about this issue. The CMS public comment period runs through February 11. You can voice your concern at the Alzheimer’s Association website by going to the treatments section at alz.org.

This draft decision is not about one treatment. It applies to the entire class of future treatments targeting amyloid. Yet, this draft decision appears to have been developed based on an individual treatment rather than the entire class. Currently approved and emerging therapies may offer individuals and their families a new tool to address cognitive decline, loss of independence, and a decreasing ability to perform activities of daily living.

This draft decision dismisses decades of research and progress now being seen for this fatal disease.”

Dr. Kenneth B. Pugar is the founder and President of the Dayton Center for Neurological Disorders