Leqembi could cost Medicare $5 billion per yr

The brand new Alzheimer’s antibody treatment Leqembi could cost Medicare as much as $5 billion per yr, in line with research published in a number one medical journal this week.

Medicare would spend about $2 billion per yr if around 85,700 patients test positive for the disease and are treated with the Eisai and Biogen product Leqembi, in line with the research published Thursday in JAMA Internal Medicine.

This system for seniors would spend $5 billion if around 216,500 patients change into eligible for the breakthrough treatment, in line with the study.

The authors said the estimated costs to Medicare are conservative and that spending on Leqembi might increase greater than anticipated depending on demand and other aspects.

The researchers who conducted the JAMA study included physicians and public health and policy experts. They’re affiliated with the University of California Los Angeles, the Rand Corporation, Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, amongst other institutions.

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

There are also additional annual costs estimated at $7,300 per patient related to neurologist visits, MRI tests and PET scans, administration of infusions, and monitoring for and treatment of potential unwanted side effects, in line with the researchers.

The study assumed Medicare would cover 80% of the prices, with patients left to pay the remaining 20% in full or partially depending on whether or not they have supplemental insurance.

Patients could face an annual bill of about $6,600 per yr depending on the state they live in and whether or not they have supplemental insurance, in line with the study. Some lower-income individuals who qualify for Medicare and Medicaid would pay nothing out of pocket.

The Alzheimer’s Association, which lobbies on behalf of patients living with the disease, estimates Alzheimer’s and other types of dementia will cost the U.S. $345 billion this yr. Those costs could rise to $1 trillion by 2050, in line with the association.

“That is the case without treatment. Prevention and treatment is the one path toward reducing this cost over time,” Robert Egge, the association’s head of public policy, said in an announcement.

“Nevertheless it’s not cost that ought to determine if people have access to life improving care — it’s concerning the impact on people,” Egge said. “Treatments taken within the early stages of Alzheimer’s could mean a greater quality of life.”

Leqembi had a positive effect on patients with early Alzheimer’s disease in clinical trial results published within the Latest England Journal of Medicine in January.

The expensive treatment shouldn’t be available to the overwhelming majority of patients straight away because Medicare has severely restricted coverage of the antibody.

Medicare has promised to supply broader coverage of Leqembi if the FDA grants full approval of the treatment in July. Leqembi received expedited 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 drop its restrictions and fully cover Leqembi.

The antibody treatment, which targets brain plaque related to the disease, slowed cognitive decline by 27% in Eisai’s clinical trial.

There are currently no other drugs available on the market which have demonstrated this level of efficacy at slowing Alzheimer’s disease. Eli Lilly’s donanemab demonstrated promising clinical trial results earlier this month. The corporate plans to use for full FDA approval this quarter.

Leqembi and donanemab each carry serious risks of brain swelling and bleeding.