First Choice Neurology

Study finds Alzheimer’s drug Leqembi would cost Medicare up to $5 billion a year

According to a study led by researchers at UCLA, the Alzheimer’s drug Leqembi would raise future costs for Medicare by $2 billion to $5 billion a year.

Leqembi, sold for $26,500 annually by Eisai Co Ltd. and Biogen Inc. was approved this year under the FDA’s administration’s accelerated pathway. Clinical trials showed it slowed cognitive decline by 27% compared with a placebo in patients with early Alzheimer’s disease.

The Centers for Medicare and Medicaid Services covers the medication only for patients enrolled in clinical trials. Medicare said it will broaden coverage if Leqembi and other Alzheimer’s drugs that remove amyloid from the brain were to receive standard FDA approval. The FDA is slated to decide by July 6 whether to grant standard approval based on evidence of Leqembi’s clinical efficacy.

Dr. Jeff Gelblum, a Miami neurologist who specializes in Alzheimer’s dementia, believes that the price is well worth the treatment. Dr. Gelblum states, “Although $5 bln per annum is a huge sum, it is far less than what is spent by Medicare in the oncology setting, where approved therapies might extend life by only several months. With our new Alzheimer’s drugs, we may extend the quality of mental functioning for several years. The cost savings in caregiver support and long-term care would outweigh the drug costs.”

There are 6 million Americans who have Alzheimer’s and receive their health coverage through Medicare.

Eisai and Biogen have estimated Leqembi would be used to treat around 100,000 U.S. patients in its first three years on the market.

Reuters wrote, The UCLA researchers estimated annual spending of $2 billion for a low-end estimate of 86,000 patients receiving Leqembi, and $5.1 billion if around 216,000 eligible patients were treated with the drug.” The cost of treating these patients “could strain the Medicare program and its beneficiaries, who may face rising premiums to help Medicare pay for the drug,” Julia Cave Arbanas, research project manager and one of the paper’s lead authors, said in a statement.

Leqembi is approved for patients in the early stages of Alzheimer’s. Anti-amyloid drugs can cause dangerous brain swelling and bleeding, requiring patients to be closely monitored through neurology visits and MRI scans, contributing to the new cost estimates. The treatment is administered through an IV every two weeks, lasting 45 to 60 minutes for each infusion. Typically, infusions can be done at hospitals and infusion therapy centers.

The Journal of the American Medical Association (JAMA) published that Medicare out-of-pocket costs for patients without a supplement health insurance policy could reach $6,600 per year. UCLA published a similar analysis last year for Eisai and Biogen’s anti-amyloid drug Aduhelm. They estimated that if a quarter of eligible adults received the drug, the annual cost to Medicare would be between $7 billion and $37 billion.

In 2021 Medicare said it would raise premiums for its plan covering physician and outpatient hospital services by a record 15%. That was scaled back after Aduhelm’s price was cut and Medicare added coverage restrictions.

UCLA’s Aduhelm spending projections were based on estimates that 1.1 million to 5.7 million Medicare beneficiaries had mild cognitive impairment or mild dementia with amyloid plaques.
Dr. John Mafi, study author said, the latest study takes our prior method one step further, by accounting for health system capacity constraints, including difficulties in accessing a primary care physician and specialist, getting screened for and formally diagnosed with cognitive impairment, and obtaining a PET scan to assess for amyloid plaque.”

The researchers cautioned that the analysis was based on estimates of brain scan results and cannot account for changes in health system capacity.

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