Leqembi could cost Medicare $5 billion per year

  • Medicare will spend $5 billion if 216,500 patients become eligible for Alzheimer’s treatment Leqembi, according to research published in JAMA Internal Medicine.
  • The study authors said that the estimated costs of the program for seniors are conservative and that expenses for Leqembi may increase more than expected.
  • Patients can face an annual bill of around $6,600 per year depending on the state they live in and whether they have supplemental insurance.
  • Medicare coverage of Leqembi is severely limited right now, although that may change in July.

The Alzheimer’s drug Leqembi is seen in this undated handout photo taken by Reuters on January 20, 2023.

Eisai | Reuters

The new Alzheimer’s antibody treatment Leqembi could cost Medicare up to $5 billion a year, according to research published in a leading medical journal this week.

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

The program for seniors will spend $5 billion if about 216,500 patients become eligible for the breakthrough treatment, according to the study.

The authors said the estimated costs to 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 doctors and experts in public health and politics. 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 the twice-monthly antibody infusions at $26,500 per year.

There are also additional annual costs estimated at $7,300 per patient associated with neurologist visits, MRI tests and PET scans, administering infusions, and monitoring and treating potential side effects, according to the researchers.

The study assumed that Medicare would cover 80% of the cost, with patients having to pay the remaining 20% ​​in whole or in part depending on whether they have additional insurance.

Patients could face an annual bill of about $6,600 per year depending on the state they live in and whether they have supplemental insurance, according to the study. Some lower-income people who qualify for Medicare and Medicaid would 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 and other forms of dementia will cost $345 billion this year. Those costs could rise to $1 trillion by 2050, according to the association.

“That is the case without treatment. Prevention and treatment is the only path toward reducing this cost over time,” Robert Egge, the association’s director of public policy, said in a statement.

“But it’s not the cost that should determine whether people have access to life-enhancing care β€” it’s about the impact on people,” Egge said. “Treatments taken in the early stages of Alzheimer’s can mean a better quality of life.”

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

The expensive treatment is not available to the overwhelming majority of patients right now because Medicare has severely limited coverage of the antibody.

Medicare has promised to provide broader coverage of Leqembi if the FDA gives 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 the restrictions and fully cover Leqembi.

The 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 this level of effectiveness in slowing Alzheimer’s disease. Eli Lilly’s donanemab showed promising results from clinical trials earlier this month. The company plans to apply for full FDA approval this quarter.

Leqembi and donanemab both have serious risks of brain swelling and bleeding.

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