Medicare Could Spend Up to $5 Billion Per Year on Alzheimer’s Antibody Treatment

Medicare Could Spend Up to $5 Billion Per Year on Alzheimer’s Antibody Treatment

A new study published in JAMA Internal Medicine suggests that Medicare could spend up to $5 billion per year on the new Alzheimer’s antibody treatment, Leqembi. If around 85,700 patients test positive and are treated with the Eisai and Biogen product, Medicare would spend approximately $2 billion per year. However, if around 216,500 patients become eligible for the treatment, the program for seniors would spend $5 billion. The authors caution that the estimated costs are conservative and that spending on Leqembi might increase more than anticipated depending on demand and other factors. The twice-monthly antibody infusions have been priced at $26,500 per year by Eisai and Biogen, with additional annual costs estimated at $7,300 per patient associated with neurologist visits, MRI tests and PET scans, administration of infusions, and monitoring for and treatment of potential side effects.

The JAMA study was conducted by physicians and public health and policy experts affiliated with the University of California Los Angeles, the Rand Corporation, Harvard Medical School, and Beth Israel Deaconess Medical Center in Boston, among other institutions.

Medicare is assumed to cover 80% of the costs, with patients left to pay the remaining 20% in full or in part depending on whether they have supplemental insurance. Patients could face an annual bill of about $6,600 per year depending on the state they live in and whether they have supplemental insurance, according to the study. Some lower-income people who qualify for Medicare and Medicaid would pay nothing out of pocket.

The Alzheimer’s Association estimates Alzheimer’s and other forms of dementia will cost the U.S. $345 billion this year. Those costs could rise to $1 trillion by 2050. “That’s the case without treatment. Prevention and treatment is the only path toward reducing this cost over time,” says Robert Egge, the association’s head of public policy. “But it’s not cost that should determine if people have access to life improving care — it’s about the impact on people. Treatments taken in the early stages of Alzheimer’s could mean a better quality of life.”

Leqembi had a positive effect on patients with early Alzheimer’s disease in clinical trial results published in the New England Journal of Medicine in January. However, the expensive treatment is not available to the majority of patients because Medicare has severely restricted coverage of the antibody. Medicare has promised to provide broader coverage of Leqembi if the FDA grants full approval of the treatment in July. The Alzheimer’s Association, members of Congress and state attorneys general are pushing for Medicare to drop its restrictions and fully cover Leqembi. The antibody treatment, which targets brain plaque associated with the disease, slowed cognitive decline by 27% in Eisai’s clinical trial. There are currently no other drugs on the market that have demonstrated this level of efficacy at slowing Alzheimer’s disease.

US

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