Will Medicare Cover the Newly FDA-Approved Alzheimer’s Drug?

Breaking news! The FDA fully approved the Alzheimer’s drug Leqembi on Thursday. But what does this mean for individuals suffering from Alzheimer’s? And will Medicare cover this newly-approved drug? Keep reading to find out.

What is Leqembi?

Leqemi is a revolutionary new Alzheimer’s drug that targets a type of protein in the brain known as beta-amyloid, long believed to be one of the underlying causes of Alzheimer’s disease. Plaque forms when beta-amyloid proteins clump together, disrupting cell-to-cell communication.

However, Leqemi might be a game-changer for many people with Alzheimer’s disease. In a recent phase 3 clinical trial, 1,795 patients suffering from varying stages of cognitive impairment took the drug. Results showed that the progression of the illness slowed by nearly 27% over 18 months. Researchers and neurologists hope it’s the first step to even more effective therapeutics in the future.

How does Leqmebi help?

During the clinical trial, researchers measured cognitive decline using a scale that measured how well patients performed in six categories. According to the results, patients who were given Leqembi showed a 27% slower rate of decline than those in the placebo group.

Donna Wilcox, the assistant dean of biomedicine at the University of Kentucky, is pleased with these results.

“In the real world, this probably means more time for the patient to live independently, enjoy their hobbies, friends, and a better quality of life,” Wilcock noted. “Time will tell to what extent, but the clinical trial showed significant benefits in everyday life.”

Will Medicare cover Leqembi?

First, it’s important to note that Leqembi is an intravenous drug, meaning that it’s injected through the veins. Patients will need to go to a hospital or clinic every two weeks for the infusion. Additionally, some Alzheimer’s experts cautioned patients, stating that they should get brain scans periodically to monitor for any potential side effects.

But will Medicare cover Leqembi?

The answer may not be as simple as it seems.

The Centers for Medicare & Medicaid Services stated that they would provide full coverage for new Alzheimer’s drugs that were granted full FDA approval. However, there’s a caveat. The agency mandated that only physicians willing to gather real-world performance data on Leqembi through a government database will be able to prescribe it.

The good news is, Medicare has promised that it will cover 80% of the drug cost if patients meet their deductible. Patients will need to pay the remaining 20% out-of-pocket. To be eligible for coverage, patients must meet the following requirements:

• They must be enrolled in Medicare.
• They must be diagnosed with mild Alzheimer’s disease or mild cognitive impairment.
• They must have a doctor or physician who has agreed to participate in data research through the government database.

While Leqembi may not be a cure, the president of the Alzheimer’s Association, Joanna Pike, is happy about this new development.

“This gives people more months of recognizing their spouse, children, and grandchildren,” Pike said in a recent statement.

For many individuals suffering from Alzheimer’s disease, that might be the biggest benefit of them all.

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