Title: Advancements in Medicare Coverage for Alzheimer’s Treatments: Providing Hope for Elderly Patients
Introduction:
As the number of Americans living with Alzheimer’s disease continues to rise, it is crucial to address the growing need for effective treatments that can slow down its progression. Medicare provides coverage for certain drugs and therapies used to treat cognitive symptoms related to Alzheimer’s disease, but the coverage for newer treatments like Adulhelm and Leqembi has been a subject of controversy and debate. This article explores the current state of Medicare coverage for Alzheimer’s treatments and delves into the implications and challenges associated with these advancements.
The Landscape of Alzheimer’s Treatments Covered by Medicare:
Medicare provides coverage for five drugs known as cholinesterase inhibitors, including Aricept, Exelon, and Razadyne, which are used to address cognitive symptoms such as memory loss and language difficulties. Additionally, Namenda and Namzaric, drugs that regulate glutamate and improve memory and speech abilities, are covered for the treatment of moderate to severe Alzheimer’s disease.
Introducing Adulhelm and Leqembi: New Treatment Options:
Adulhelm and Leqembi, both intravenous anti-amyloid antibody infusion therapies, have garnered significant attention due to their potential to slow down the progression of early-stage Alzheimer’s disease. Adulhelm received accelerated approval from the FDA, sparking a discussion about its coverage under Medicare. CMS, the Centers for Medicare and Medicaid Services, decided to cover Adulhelm and similar treatments for Medicare Part B beneficiaries enrolled in approved clinical trials. However, this decision has faced criticism and raised concerns about accessibility for patients, particularly those residing in rural and underserved areas.
The Challenges of Implementing Medicare Coverage:
The introduction of a registry for doctors and patients participating in Alzheimer’s drug treatments has been met with resistance from critics who view it as an unnecessary obstacle. The Alzheimer’s Association argues that Medicare coverage should be accessible to all eligible individuals, regardless of their inclusion in the registry. The ongoing discussions surrounding the coverage of Leqembi, the similar treatment to Adulhelm, further complicate the landscape of Medicare coverage for Alzheimer’s treatments.
Public Opinion and Future Implications:
Surveys indicate overwhelming support among voters for Medicare’s coverage of FDA-approved drugs that may slow down the progression of Alzheimer’s disease. The potential expansion of coverage to include Lilly’s donanemab, another drug showing clinical benefits for early-stage Alzheimer’s patients, further underscores the evolving landscape of Medicare coverage for Alzheimer’s treatments. However, the financial implications of these advancements cannot be ignored, as the cost of medications like Leqembi could impact Medicare spending and premiums.
Expanding Access and Ensuring Affordability:
While advancements in Medicare coverage for Alzheimer’s treatments offer hope to affected individuals and their families, efforts must be made to expand access and ensure affordability. Collaborative initiatives between healthcare providers, government agencies, and pharmaceutical companies can help address logistical challenges and concerns regarding accessibility and cost. Additionally, ongoing research and the development of alternative treatment options are essential to provide more comprehensive and affordable care for individuals living with Alzheimer’s disease.
Conclusion:
Medicare coverage for Alzheimer’s treatments has evolved over time, with both progress and challenges. While current coverage includes certain drugs for cognitive symptoms, the coverage of innovative treatments like Adulhelm and Leqembi remains limited. Public opinion supports Medicare’s coverage of FDA-approved drugs, providing hope for the expansion of accessible treatments. However, balancing access, affordability, and regulatory considerations is essential. By addressing these factors and fostering collaboration, the healthcare system can continue to improve the lives of individuals living with Alzheimer’s disease.
Summary:
Approximately 6.7 million Americans aged 65 or older are living with Alzheimer’s disease. While Medicare provides coverage for certain drugs used to treat cognitive symptoms, the coverage for innovative treatments like Adulhelm and Leqembi is complex and evolving. Adulhelm received accelerated approval from the FDA, leading to Medicare coverage for eligible beneficiaries enrolled in approved clinical trials. However, challenges surrounding accessibility and affordability have surfaced, with critics questioning the necessity of a registry. Public support for Medicare coverage of FDA-approved Alzheimer’s drugs is strong. The future implications of expanding coverage to include other treatments and the financial impact on Medicare spending and premiums are being carefully considered. Efforts to expand access, ensure affordability, and foster collaboration are crucial in improving care for individuals living with Alzheimer’s disease.
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Approximately 6.7 million Americans are age 65 or older Living with Alzheimer’s Disease. Many of them could benefit from treatments that could slow the progression of the disease. Does Medicare Cover Treatments and Medications to Help Them? The answer is complicated and constantly changing. Here’s what you need to know:
Medicare and Alzheimer’s drugs
There are no drugs or treatments to cure Alzheimer’s disease. However, if you have a Medicare Part D prescription drug plan, you can get Medicare coverage for five drugs used to treat cognitive symptoms.
Three of them – Aricept, Excelon and Razadyne – are cholinesterase inhibitors that treat symptoms related to memory, language, judgment and other thought processes. Aricept has been approved by the FDA to treat all stages of Alzheimer’s disease. Exelon and Razadyne have received approval for mild to moderate disease.
Namenda and Namzaric are approved for the treatment of moderate to severe Alzheimer’s disease. Namenda is a glutamate regulator and Namzaric is a combination cholinesterase inhibitor and glutamate regulator. Both are prescribed to improve memory, speech, and the ability to perform simple tasks.
Does Medicare cover Adulhelm and Leqembi?
There’s a new type of Alzheimer’s treatment that’s getting a lot of attention because it may slow the progression of the disease. Adulhelm and Leqembi are costly intravenous (IV) anti-amyloid antibody infusion therapies for people with early-stage Alzheimer’s.
After a complicated regulatory process in recent years, Medicare is adopting Adulhelm for certain people with early-stage Alzheimer’s.
In June 2021, “The FDA disagreed with the advice of its Advisory Committee and granted accelerated approval to Adulhelm.” CMS [The Centers for Medicare and Medicaid Services, which runs Medicare] Then he said, “Let’s think about what we want to do about it,” says Tricia Neuman, senior vice president of the health policy research and news organization KFF and executive director of the Medicare policy program.
Medicare usually covers what the FDA approves.
In April 2022, CMS decided that Medicare would cover Adulhelm (cost: $28,200 per year, down from the original price of $56,000) and similar treatments only for Medicare Part B beneficiaries who are enrolled in an agency-approved or National Institutes of Health-approved clinical trial.
“We were very disappointed with the way CMS chose to have these FDA-approved Alzheimer’s treatments covered by Medicare or not,” said Robert Egge, chief public policy officer of the Alzheimer’s Association. “These treatments could make a big difference in the lives of patients with early-stage Alzheimer’s,” he adds.
The Alzheimer’s Group said in a statement following the April 2022 CMS decision, “With this approach, only the privileged few with access to clinical trials will have access to treatment.”
Finding a healthcare provider to administer Adulhelm can be difficult. Some healthcare systems, including Cleveland Clinic, Mass General Brigham and Mount Sinai in New York City have said they will not administer it due to safety and efficacy concerns, according to the Commonwealth Fund, a health research group.
If Medicare covers Adulhelm, 80% of the cost will be covered. The beneficiary pays the remainder, which is approximately $5,640 per year. The average deductible limit for people with Medicare benefit Health insurer plans — the private alternative to traditional Medicare — are just over $5,100.
In November 2022, CMS increased the monthly Part B premium by $21.60 to $170.10 due to Medicare’s projected higher spending on Adulhelm insurance. Part B premium dropped to $164.90 for 2023.
Leqembi, the similar treatment used to slow Alzheimer’s disease, received “accelerated approval” from the FDA in January 2023. The Veterans Health Administration started reporting it for some veterans over 65 in March 2023.
In early June, CMS said Medicare would pay for eligible beneficiaries if the FDA grants traditional approvals for drugs that slow the progression of Alzheimer’s disease if a physician also participates in a special registry.
Some critics believe that a registry for doctors and patients could be cumbersome and exclude patients in rural and underserved areas.
Diane Omdahl, author of Medicare for you and CEO of Medicare consulting firm 65 Incorporated, says a registry “will definitely be a barrier to people getting Alzheimer’s drugs.”
The Alzheimer’s Association calls a registry “an unnecessary obstacle” to insurance coverage.
“You should be eligible for Medicare coverage whether you’re on a registry or not,” says Egge. “This has been the case with every other FDA-approved drug without exception.”
By July 6, the FDA will decide whether to grant Leqembi full approval for all people with mild cognitive impairment or mild dementia with amyloid plaques.
The CMS then has to decide whether and how Medicare will cover the costs and whether the insurance rules for Aduhelm should be changed.
Nearly nine out of ten voters support Medicare covering FDA-approved drugs that may slow the progression of Alzheimer’s disease, a current survey found by Lake Research Partners and Public Opinion Strategies.
In the coming months, Medicare will also announce whether it covers Lilly’s donanemab, another drug that has demonstrated clinical benefit for people with early-stage Alzheimer’s. A clinical study showed that this drug slowed the progression of Alzheimer’s disease by 35% compared to a placebo.
Will Medicare eventually provide coverage to all people with Alzheimer’s who are eligible for these drugs? “After so much frustration, I’m cautiously optimistic,” says Egge.
At a list price of $26,500, Leqembi could increase annual Medicare Part B spending by $8.9 billion if 5% of people with Alzheimer’s (about 335,000) take it, KFF estimates. It would likely increase Part B premiums as well, Omdahl notes.
However, the Alzheimer’s Association estimates that only about 100,000 people will take Adulhelm and Leqembi for a number of years.
The annual cost for Leqembi and Adulhelm approaches the median income of $30,000 for Medicare beneficiaries.
https://fortune.com/well/2023/06/15/does-medicare-pay-for-alzheimers-drugs/
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