Medicare Expands Coverage to Include New Class of Alzheimer's Drugs

In a significant development, Medicare has announced its plans to provide broad coverage for a new class of Alzheimer’s drugs following their full approval by the Food and Drug Administration (FDA). Two drugs in the new class,  Leqembi and Aduhelm, are not yet fully approved by the FDA. This decision by the Centers for Medicare & Medicaid Services (CMS) aims to ensure that eligible patients enrolled in Medicare Part B can access these potentially life-changing medications. Additionally, certain criteria must be met, including the participation of patients’ physicians and clinical teams in registries to gather real-world evidence on the effectiveness of these drugs.

Expanding Access to Alzheimer’s Drugs

CMS has taken a proactive stance by recognizing the importance of covering these costly Alzheimer’s drugs for Medicare beneficiaries. The decision will enable eligible patients to access treatments that hold promise in managing the symptoms and progression of this debilitating disease. Among the notable drugs in this new class is Leqembi, which comes with an annual price tag of $26,500.

Financial Impact and Benefits:

While the coverage of these Alzheimer’s drugs once fully approved by the FDA represents a significant step forward, it is crucial to acknowledge the financial implications. Estimates suggest that Leqembi alone could lead to an approximate $8.9 billion annual impact on Medicare Part B spending. This figure is comparable to the combined spending on the top three Part B drugs in 2021. Nevertheless, the potential benefits for patients, in terms of improved quality of life and disease management, make this a worthwhile investment in healthcare.

CMS has taken a proactive stance by recognizing the importance of covering these costly Alzheimer’s drugs for Medicare beneficiaries.”

Medicare’s decision to include coverage of a new class of Alzheimer’s drugs marks a significant milestone in improving access to innovative treatments for patients in need. By expanding coverage for these medications, CMS recognizes the urgency and impact of addressing Alzheimer’s disease. As the healthcare landscape continues to evolve, initiatives like this contribute to advancing patient care and fostering hope for individuals and their families affected by this devastating condition.

To learn more about Medicare’s decision to expand coverage for this new class Alzheimer’s drugs, once fully approved by the FDA, you can read the full article here.

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