The Alzheimer’s drug Leqembi is visible on this undated image obtained by Reuters on January 20, 2023.
Hey | Reuters
A latest antibody treatment for Alzheimer’s disease, Leqembi, could cost Medicare as much as $5 billion a year tests published this week in a leading medical journal.
Medicare will spend about $2 billion a year if about 85,700 patients test positive for the disease and are treated Hey AND Biogen Leqembi product, in line with research published Thursday in JAMA Internal Medicine.
In response to the study, the senior program would cost $5 billion if some 216,500 patients qualified for the breakthrough treatment.
The authors said Medicare cost estimates are conservative, and spending on Leqembi could increase greater than projected, depending on demand and other aspects.
The scientists who conducted the JAMA study included physicians and public health and policy experts. They’re affiliated with the University of California Los Angeles, Rand Corporation, Harvard Medical School, and Beth Israel Deaconess Medical Center in Boston, amongst others.
Eisai and Biogen have priced antibody infusions twice a month at $26,500 a year.
There are also additional annual costs, estimated at $7,300 per patient, for neurologist visits, MRI and PET scans, administering infusions, and monitoring and treating potential unwanted effects, in line with the researchers.
The study assumed that Medicare would cover 80% of the cost, and patients would need to pay the remaining 20% in full or partially, depending on whether or not they had supplemental insurance.
In response to the study, patients can have an annual bill of around $6,600 a year, depending on where they live and whether or not they have supplemental insurance. Some lower-income individuals who qualify for Medicare and Medicaid would pay nothing out-of-pocket.
The Alzheimer’s Association, which lobbies for patients living with the disease, estimates that Alzheimer’s and other types of dementia will cost $345 billion this year. In response to the association, these costs could rise to $1 trillion by 2050.
“That is what happens when there is no such thing as a treatment. Prevention and treatment is the one solution to reduce these costs over time,” Robert Egge, head of the general public policy association, said in a statement.
“Nevertheless it’s not cost that ought to determine whether or not people have access to life-enhancing care – it’s concerning the impact on people,” Egge said. “Treatment taken within the early stages of Alzheimer’s disease can mean a higher quality of life.”
Leqembi had a positive effect on patients with early-onset Alzheimer’s disease in clinical trial results published within the Latest England Journal of Medicine in January.
Expensive treatment is currently not available to the overwhelming majority of patients because Medicare has severely limited antibody coverage.
Medicare has promised to supply wider coverage for Leqembi if the FDA gives full approval for the treatment in July. Leqembi received accelerated approval from the Food and Drug Administration in January.
The Alzheimer’s Association, members of Congress and state attorneys general are pushing for Medicare to lift restrictions and fully cover Leqembi.
Treatment with antibodies that concentrate on disease-related brain plaque slowed cognitive decline by 27% within the Eisai clinical trial.
Currently, there aren’t any other drugs in the marketplace which have shown such effectiveness in slowing down Alzheimer’s disease. Eli Lilly’Donanemab showed promising leads to clinical trials earlier this month. The corporate plans to hunt full FDA approval this quarter.
Leqembi and donanemab carry a serious risk of brain swelling and bleeding.