Alzheimer’s treatment Leqembi could cost Medicare up to $5 billion per year, study estimates

The Alzheimer’s drug LEQEMBI is seen on this undated handout picture obtained by Reuters on January 20, 2023.

Eisai | Reuters

The brand new Alzheimer‘s antibody therapy Leqembi might value Medicare as much as $5 billion per yr, in accordance with research printed in a number one medical journal this week.

Medicare would spend about $2 billion per yr if round 85,700 sufferers check constructive for the illness and are handled with the Eisai and Biogen product Leqembi, in accordance with the analysis printed in JAMA Inner Medication on Thursday.

This system for seniors would spend $5 billion if round 216,500 sufferers grow to be eligible for the breakthrough therapy, in accordance with the research.

The authors stated the estimated prices to Medicare are conservative, and spending on Leqembi may improve greater than anticipated relying on demand and different components.

The researchers who carried out the JAMA research included physicians, together with public well being and coverage consultants. They’re affiliated with the College of California Los Angeles, the Rand Company, Harvard Medical College and Beth Israel Deaconess Medical Middle in Boston, amongst different establishments.

Eisai and Biogen have priced the twice month-to-month antibody infusions at $26,500 per yr.

There are additionally an estimated $7,300 in further annual prices per affected person related to neurologist visits, MRI exams and PET scans, administration of infusions, and monitoring for and therapy of potential uncomfortable side effects, in accordance with the researchers.

The research assumed Medicare would cowl 80% of the prices with sufferers left to pay the remaining 20% in full or partially relying on whether or not they have supplemental insurance coverage.

Sufferers might face an annual invoice of about $6,600 per yr relying on the state they stay in and whether or not they have supplemental insurance coverage, in accordance with the research. Some lower-income individuals who qualify for Medicare and Medicaid would pay nothing out of pocket.

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The Alzheimer’s Affiliation, which lobbies on behalf of sufferers dwelling with the illness, estimates Alzheimer’s and different types of dementia will value the U.S. $345 billion this yr. These prices might rise to $1 trillion by 2050, in accordance with the affiliation.

“That is the case with out therapy. Prevention and therapy is the one path towards decreasing this value over time,” Robert Egge, the affiliation’s head of public coverage, stated in an announcement.

“However it’s not value that ought to decide if folks have entry to life enhancing care — it is in regards to the influence on folks,” Egge stated. “Therapies taken within the early levels of Alzheimer’s might imply a greater high quality of life.”

Leqembi had a constructive impact on sufferers with early Alzheimer’s illness in scientific trial outcomes printed within the New England Journal of Medication in January.

The costly therapy is just not obtainable to the overwhelming majority of sufferers proper now as a result of Medicare has severely restricted protection of the antibody.

Medicare has promised to supply broader protection of Leqembi if the FDA grants full approval of the therapy in July. Leqembi acquired expedited approval from the Meals and Drug Administration in January.

The Alzheimer’s Association, members of Congress and state attorneys general are pushing for Medicare to drop its restrictions and absolutely cowl Leqembi.

The antibody therapy, which targets mind plaque related to the illness, slowed cognitive decline by 27% in Eisai’s scientific trial.

There are at present no different medicine available on the market which have demonstrated this degree of efficacy at slowing Alzheimer’s illness. Eli Lilly’s donanemab demonstrated promising scientific trial outcomes earlier this month. The corporate plans to use for full FDA approval this quarter.

Leqembi and donanemab each carry critical dangers of mind swelling and bleeding.

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