- Medicare would spend $5 billion if 216,500 patients were eligible for Alzheimer’s treatment in Leqembi, according to a study published in JAMA Internal Medicine.
- The study’s authors said the estimated costs for the program for seniors are conservative and that spending on Leqembi could increase more than expected.
- Patients could end up with an annual bill of around $6,600 per year, depending on what state they live in and whether they have supplemental insurance.
- Leqembi’s Medicare coverage is currently severely limited, but that could change in July.
Alzheimer’s drug Leqembi can be seen in this undated handout picture obtained by Portal on January 20, 2023.
Eisai | Portal
New Alzheimer’s antibody treatment Leqembi could cost Medicare up to $5 billion a year, according to a study published this week in a leading medical journal.
Medicare would spend about $2 billion a year if about 85,700 patients tested positive for the disease and were treated with Eisai and Biogen’s product Leqembi, according to the study published Thursday in JAMA Internal Medicine.
According to the study, the program would spend $5 billion for seniors if approximately 216,500 patients are eligible for the breakthrough treatment.
The authors said the estimated costs for Medicare are conservative and that spending on Leqembi could increase more than expected depending on demand and other factors.
The researchers who conducted the JAMA study included physicians and Public health and policy experts. They are affiliated with the University of California Los Angeles, Rand Corporation, Harvard Medical School and the Beth Israel Deaconess Medical Center in Boston, among others.
Eisai and Biogen have priced the twice-monthly antibody infusions at $26,500 per year.
There are also additional annual costs estimated at $7,300 per patient associated with visits to the neurologist, MRI and PET scans, administration of IV fluids, and monitoring and treatment of possible side effects, according to the researchers.
The study assumed that Medicare would cover 80% of the cost, while patients would have to pay all or part of the remaining 20%, depending on whether they had supplemental insurance.
According to the study, patients could expect an annual bill of about $6,600 per year, depending on which state they live in and whether they have supplemental insurance. Some lower-income people who are eligible for Medicare and Medicaid would not pay anything out of pocket.
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The Alzheimer’s Association, which works to help patients with the disease, estimates that Alzheimer’s and other forms of dementia will cost the United States $345 billion this year. According to the association, these costs could increase to $1 trillion by 2050.
“This is the case without treatment. Prevention and treatment is the only way to reduce these costs over time,” Robert Egge, the association’s head of public policy, said in a statement.
“But it’s not the cost that should decide whether people have access to life-improving care – it’s the impact on people,” Egge said. “Treatments in early-stage Alzheimer’s disease could lead to a better quality of life.”
Clinical study results published in the New England Journal of Medicine in January showed that Leqembi had a beneficial effect on patients with early Alzheimer’s disease.
The expensive treatment is currently unavailable to the vast majority of patients because Medicare has severely restricted coverage of the antibody.
Medicare has promised to provide broader coverage for Leqembi if the FDA grants full approval for the treatment in July. Leqembi received accelerated approval from the Food and Drug Administration in January.
The Alzheimer’s Association, congressmen and attorneys general are pushing for Medicare to drop its restrictions and give Leqembi full coverage.
Antibody treatment, which targets brain plaques 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 shown comparable effectiveness in slowing down Alzheimer’s disease. Eli Lilly’s donanemab showed promising clinical trial results earlier this month. The company plans to file for full FDA approval this quarter.
Leqembi and donanemab both carry a serious risk of brain swelling and bleeding.