The Alzheimer’s disease drug LEQEMBI is seen in this undated posted photo obtained by Reuters on January 20, 2023.
Isai | Reuters
Leqembi’s new Alzheimer’s antibody treatment could cost Medicare up to $5 billion a year, according to research published in a leading medical journal this week.
Medicare will spend about $2 billion annually if about 85,700 patients test positive for the disease and are treated with Esay And Biogen Leqembi product, according to research published in JAMA Internal Medicine on Thursday.
According to the study, the program for seniors would spend $5 billion if about 216,500 patients became eligible for the staggering treatment.
The authors said the estimated costs for Medicare are conservative, and spending on Leqembi may increase more than expected depending on demand and other factors.
The researchers who conducted the JAMA study included physicians, along with Public health and policy experts. They are 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.
Eisai and Biogen have priced twice-monthly antibody injections at $26,500 per year.
There are also an estimated $7,300 in additional annual costs per patient associated with neurologist visits, MRI exams, PET scans, injection administration, and monitoring and treatment for potential side effects, according to the researchers.
The study assumed that Medicare would cover 80% of the costs with patients left to pay the remaining 20% in whole or in part depending on whether they had supplemental insurance.
Patients may face an annual bill of about $6,600 per year depending on which state they live in and whether they have supplemental insurance, according to the study. Some low-income people who qualify for Medicare and Medicaid will pay nothing out of pocket.
The Alzheimer’s Association, which lobbies on behalf of patients living with the disease, estimates that Alzheimer’s and other forms of dementia will cost $345 billion this year. Those costs could rise to $1 trillion by 2050, according to the association.
“This is the case without a cure. Prevention and treatment are the only way to reduce this cost over time,” Robert Egge, the federation’s chief of public policy, said in a statement.
“But it’s not the cost that should determine whether people have access to life-enhancing care — it’s about the impact on people,” Egge said. “Therapies taken in the early stages of Alzheimer’s disease can mean a better quality of life.”
Leqembi had a positive effect on patients with early-onset Alzheimer’s disease in clinical trial results published in the New England Journal of Medicine in January.
The expensive treatment is not available to the vast majority of patients right now because Medicare has severely restricted antibody coverage.
Medicare has promised broader coverage for Leqembi if the US Food and Drug Administration (FDA) grants full approval of the treatment in July. Leqembi received emergency approval from the Food and Drug Administration in January.
The Alzheimer’s Association, members of Congress and state attorneys general are pressing for Medicare to repeal its restrictions and fully cover Leqembi.
Antibody therapy, which targets brain plaques associated with the disease, slowed cognitive decline by 27% in the Eisai clinical trial.
There are currently no other medications on the market that have shown this level of effectiveness in slowing Alzheimer’s disease. Eli Lillydonanemab showed promising clinical trial results earlier this month. The company plans to apply for full FDA approval this quarter.
Leqembi and donanemab both carry serious risks of brain swelling and bleeding.