Some Medical Insurers Won't Cover Cost of New Alzheimer's Treatment
(NEWSnet/AP) – Some private insurers are balking at the expected cost of the first drug fully approved to slow mental decline in Alzheimer’s patients.
Insurers selling coverage in North Carolina, Pennsylvania and New York, among other states, told The Associated Press they won’t cover Leqembi with insurance offered on the individual market and through employers because they consider the $26,000-a-year drug to be experimental.
That decision stands in contrast to Medicare, which will indeed cover its patients who take the drug. The federal program, which is mainly for people ages 65 and older, announced shortly after Leqembi received full approval last month that it will cover the treatment even while tracking its safety and effectiveness.
Leqembi is the first medicine that’s been convincingly shown to slow the cognitive decline caused by Alzheimer’s disease, though only modestly. Some Alzheimer's experts say the delay may be too subtle for patients or their families to notice.
The U.S. Food and Drug Administration approved the IV drug for patients with mild dementia and other symptoms caused by early Alzheimer’s. That step came after regulators reviewed data from a study in which the drug slowed memory and thinking decline by about five months in those who got the treatment, compared with those who got a dummy drug.
About 76% of the people taking Leqembi will be covered by Medicare, according to the Japanese drugmaker Eisai, which developed the drug and is co-marketing it with Cambridge, Massachusetts-based Biogen Inc.
But people under 65 — even, rarely, as young as their 30s — also can get diagnosed. That age bracket is more likely to have commercial coverage rather than the federal plan.
“That’s why we’re just dumbfounded that commercial plans are not covering it,” said Christine Mann, chief operating officer of the Buffalo, N.Y.-area Dent Neurologic Institute, which will provide the IV drug to patients.
For now, some commercial insurers have said yes, some have said not at this time, and many others have yet to make a decision.
Most insurers will probably cover the drug, but heavily restrict its use through steps like requiring pre-approval, said Greg Warren, a health actuary and member of the Society of Actuaries.
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