Subsequent 12 months’s Medicare Half B premiums are anticipated to be introduced quickly and there may be hypothesis that protection of one other expensive new Alzheimer’s medicine may trigger month-to-month prices to go up, echoing what occurred in 2022.
Leqembi obtained full approval from the Meals and Drug Administration (FDA) in July, changing into the second drug of its variety to hit the market after Aduhelm. The drug comes with an annual price of $26,500.
Whereas solely permitted for sufferers with gentle cognitive impairment or gentle dementia who’re additionally confirmed to have a mind plaque known as amyloid, the pharmaceutical business expects Leqembi to be common.
Whereas the medicine just isn’t a remedy for Alzheimer’s illness, Leqembi is the primary drug to display medical advantages to sufferers by slowing down the development of the illness. That is completed by concentrating on and decreasing amyloid plaque within the mind, the buildup of which is linked to cognitive decline.
Leqembi’s producer Eisai estimates about 100,000 individuals can be eligible to take the drug within the U.S. by the third 12 months of its availability, and Medicare’s protection of the drug ought to open up entry to it. However some have posited that 100,000 in three years may very well be a conservative estimate.
Tricia Neuman, KFF senior vice chairman and govt director for its program on Medicare coverage, famous the precise uptake of Alzheimer’s drugs amongst Medicare beneficiaries isn’t recognized.
The true variety of sufferers who may gain advantage from Leqembi is unclear as a result of it’s tough to precisely estimate how many individuals with Alzheimer’s illness have gentle instances.
“The quantity and proportion of older adults who’ve [Mild Cognitive Impairment] on account of Alzheimer’s illness is at the moment tough to estimate as a result of they require population-based prevalence measures of MCI and Alzheimer’s biomarkers, and this line of analysis is in its infancy,” the Alzheimer’s Affiliation famous in its 2023 Alzheimer’s Illness Details and Figures report.
The factors for MCI can be totally different throughout totally different research, additional complicating estimates. The Alzheimer’s Affiliation noticed that some research estimate 17 % of individuals 65 and older have MCI whereas others estimate anyplace between 8 and 11 %.
As KFF famous in a report earlier this 12 months, an uptake of 100,000 would signify 1.5 % of U.S. adults with Alzheimer’s — an estimated 6.5 million individuals — and even that diploma of use would make Leqembi the third costliest drug to be coated by Medicare Half B.
In 2023, the month-to-month premium of Medicare Half B fell for the primary time in 10 years, going from $170.10 a month to $164.90.
This drop was preceded by a serious premium hike in 2022 — 15 % — that was attributed to Medicare’s protection of the brand new Alzheimer’s drug Aduhelm. The Division of Well being and Human Providers (HHS) would later decide that the rise on account of Aduhlem was overestimated, resulting in the premium being lowered.
The Medicare Board of Trustees estimated the Medicare Half B premium for 2024 may very well be $174.80 in its annual report launched this 12 months, marking a 6 % improve. This alteration wouldn’t be among the many highest jumps seen in recent times. Neuman famous the estimate, put out six months in the past, may change on account of quite a few components separate from Medicare’s protection of Leqembi.
“It’s tough to know precisely what the Half B premium can be in 2024 or how will probably be influenced by any given drug, together with Leqembi,” mentioned Neuman.
“The Half B premium is influenced by quite a few components, like development in spending for different companies like doctor companies and hospital outpatient companies and the medicine which are administered by physicians,” she added.
When reached for touch upon when the ultimate Medicare Half B premium for 2024 can be introduced, the Facilities for Medicare and Medicaid (CMS) mentioned it expects to launch that info a while within the fall.
Copyright 2023 Nexstar Media Inc. All rights reserved. This materials might not be revealed, broadcast, rewritten, or redistributed.