Lekembi could cost Medicare $5 billion a year

  • According to a study published in JAMA Internal Medicine, Medicare would spend $5 billion if 216,500 patients were eligible for the Alzheimer’s treatment Rekumbi.
  • The study authors said the estimated costs of programs for seniors were modest and that spending on Rekumbi could be higher than expected.
  • Patients can face claims of approximately $6,600 annually, depending on the state they live in and whether they have additional insurance.
  • Rekumbi’s Medicare coverage is currently severely restricted, but that could change in July.

This undated handout image, obtained by Reuters on January 20, 2023, shows the Alzheimer’s drug Rekumbi.

Eisai | Reuters

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

About 85,700 patients who tested positive for the disease and were treated with Leqembi, a product from Eisai and Biogen, would save Medicare a year, according to study results published Thursday in the journal JAMA Internal Medicine. It is expected to spend about $2 billion.

Studies show that if about 216,500 patients qualify for breakthrough treatments, $5 billion will be spent on programs for the elderly.

The authors said Medicare cost estimates were conservative and that spending on Lekembi could be higher than expected, depending on demand and other factors.

The researchers who conducted the JAMA study included physicians and physicians. Public health and policy expert. They have partnered with, among others, the University of California, Los Angeles, Rand Corporation, Harvard Medical School, and Beth Israel Deaconess Medical Center in Boston.

Eisai and Biogen are priced at $26,500 a year for twice-monthly antibody drips.

There are also additional costs, estimated at $7,300 per patient per year, related to neurologist visits, MRI and PET scans, intravenous fluid administration, and monitoring and treatment of potential side effects, the researchers said. It says.

The study assumes that Medicare will cover 80% of the cost, and patients will pay the remaining 20% ​​in full or in part, depending on whether they have additional insurance.

Patients can face claims of about $6,600 annually, according to research, depending on the state they live in and whether they have additional insurance. Some low-income people who qualify for Medicare or Medicaid don’t pay out-of-pocket at all.

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The Alzheimer’s Association, which lobbies on behalf of people with Alzheimer’s disease, estimates that Alzheimer’s and other dementias will cost $345 billion this year. Those costs could rise to $1 trillion by 2050, according to the association.

“Without treatment, it is. Prevention and treatment are the only ways to reduce these costs in the long term,” Robert Egge, the association’s public policy director, said in a statement.

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

Clinical trial results published in the New England Journal of Medicine in January showed that Lekemi had a positive effect on patients with early Alzheimer’s disease.

The vast majority of patients currently have no access to expensive treatments because of Medicare’s severely limited antibody coverage.

Medicare has promised to expand Rekembi’s coverage if the FDA fully approves the treatment in July. Leqembi received accelerated approval from the Food and Drug Administration in January.

The Alzheimer’s Association, lawmakers, and state attorneys general are calling for Medicare’s restrictions to be lifted and Lekumbi to be fully covered.

An Eisai clinical trial found that an antibody treatment that targets brain plaques associated with the disease slowed cognitive decline by 27%.

Currently, no other drug on the market has demonstrated this level of efficacy in slowing the progression of Alzheimer’s disease. Eli Lilly’s donanemab showed promising clinical trial results earlier this month. The company plans to apply for full FDA approval this quarter.

Both lekumbi and donanemab carry serious risks of brain swelling and bleeding.

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