Leqembi could cost Medicare $5 billion a year


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

Eisai Reuters

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.

If about 85,700 patients test positive for the disease and are treated, Medicare will spend about $2 billion a year. Eisai And biogenic Leqembi’s product, according to a study published Thursday in JAMA Internal Medicine.

According to the study, if about 216,500 patients are eligible for breakthrough treatment, the program for the elderly will cost $5 billion.

The authors said the estimated costs for Medicare are conservative and that costs for Leqembi may be higher than expected depending on demand and other factors.

Doctors were among the researchers who conducted the JAMA study 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 estimated twice-monthly infusions of antibodies at $26,500 per year.

According to the researchers, the additional annual costs per patient associated with neurologist visits, MRI and PET scans, infusions, and monitoring and treatment for potential side effects are about $7,300.

The study estimated that Medicare would cover 80% of costs, and patients would have to pay all or part of the remaining 20%, depending on whether they had additional insurance.

According to the study, patients could face a bill of about $6,600 a year, depending on their state of residence and whether they have additional insurance. Some low-income people who qualify for Medicare and Medicaid pay nothing out of pocket.

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The Alzheimer’s Association, which lobbies on behalf of patients living with the disease, estimates that Alzheimer’s disease and other forms of dementia will cost the United States $345 billion this year. According to the association, these costs could reach 1 trillion dollars by 2050.

“This is an untreated condition. Prevention and treatment are the only ways to reduce these costs over time,” said Robert Egge, the association’s public policy officer.

“But it’s not the cost that determines whether people have access to life-enhancing care, it’s the impact on people,” Egge said. “Treatments taken early in Alzheimer’s disease may improve quality of life.”

Leqembi showed positive results in patients with early-stage Alzheimer’s disease in clinical trials published in January in the New England Journal of Medicine.

The expensive treatment is currently out of reach for the vast majority of patients because Medicare has severely limited coverage for the antibodies.

Medicare has pledged to expand Leqembi coverage if the FDA gives full approval to the treatment in July. Lakembi received expedited approval from the Food and Drug Administration in January.

The Alzheimer’s Association, members of Congress and state attorneys general are calling for Medicare to lift the restrictions and cover Lakemby entirely.

Antibody treatment targeting disease-associated brain plaque slowed cognitive decline by 27% in Eisai’s clinical trial.

Currently, there is no drug on the market that has shown such efficacy in slowing Alzheimer’s disease. Eli Lilly’s donanemab showed promising clinical trial results earlier this month. The company expects to receive full FDA approval this quarter.

Both lekembi and donanemab carry a risk of brain swelling and bleeding.

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