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  • John Grant

There’s a Tug-of-War Over Alzheimer’s Drug

Six million Americans suffer from Alzheimer’s disease.‭ ‬One in‭ ‬10‭ ‬people over the age of‭ ‬65‭ ‬have it.‭ ‬Alzheimer’s and other dementias cost the nation more than‭ ‬$290‭ ‬billion,‭ ‬including‭ ‬$195‭ ‬billion in Medicare and Medicaid payments.‭ ‬It’s easy to see why there is great demand for new treatments.

In an unprecedented move last June,‭ ‬the Food and Drug Administration‭ (FDA)‬accelerated‭ ‬approval for a new drug called ADUHELM.‭ ‬The agency did this despite a unanimous‭ “‬no‭” ‬vote from its scientific advisory panel.‭ ‬Studies show the drug from Biogen Inc.,‭ ‬reduced the abnormal deposits of protein found in the brains of Alzheimer’s patients.‭ ‬It was the first‭ ‬Alzheimer’s‭ ‬treatment given the green light since‭ ‬2003.‭

Opponents disagree with the FDA’s decision suggesting more studies are needed to prove the drug’s benefits and safety.‭ ‬U.S.‭ ‬insurers‭ ‬are some of the biggest opponents,‭ ‬expressing the need for‭ ‬more scientific evidence before paying‭ ‬$56,000-a-year‭ ‬per patient‭ ‬for the‭ ‬drug.‭ ‬In a recent Bloomberg News survey,‭ ‬none of the‭ ‬25‭ ‬large insurers deemed the drug‭ “‬medically necessary‭” ‬because a clinical benefit has not been established.‭ ‬Most of them are calling it experimental.

ADUHELM is a first-in-class approved therapy.‭ ‬Biogen says‭ ‬that categorization‭ ‬is exactly how multiple sclerosis and many forms of cancer changed from untreatable diseases into conditions with viable treatment options.‭ ‬“By addressing a defining pathology of the disease,‭ ‬this novel therapy has the potential to help fundamentally change the way patients are diagnosed and treated,‭” ‬the company concludes.

Some patients are paying out of pocket.‭ ‬Some providers are using‭ ‬ADUHELM‭ ‬but‭ ‬have just five hours per patient to‭ ‬plead a case to an insurer.‭ ‬Most of the time,‭ ‬coverage is denied.‭ ‬Medicare,‭ ‬which covers‭ ‬63-million elderly or disabled Americans,‭ ‬says it‭ ‬will wait until April to set its final policy.‭ ‬But it’s already raising premiums in anticipation of demand for this very pricey drug.

Humana,‭ ‬the second-largest Medicare insurer in the nation,‭ ‬is covering‭ ‬the‭ ‬cost‭ ‬for members who are showing similar results that occurred in clinical trials.‭ ‬The Veterans’‬ Health Administration and Cigna‭ ‬have made agreements with Biogen and that’s expected to help make the treatment available to eligible patients.‭ ‬But more insurers will need to get on board despite the hefty price tag.‭ ‬Biogen maintains the price of ADUHELM reflects the overall value this treatment brings to patients,‭ ‬caregivers and society.

What you can be sure of is Seniors Across America (SAA) will keep an eye on ADUHELM developments,‭ ‬a drug the FDA calls‭ “‬reasonably and likely‭” ‬effective.‭ ‬SAA will‭ ‬advocate for‭ ‬ older Americans‭ ‬so they can‭ ‬have the‭ ‬medicine‭ ‬they need to live a better life.‭

John Grant, a former state representative and state senator, an estate planning attorney, and a member of the National Senior Citizen Hall of Fame, has spent much of his career working on behalf of seniors. John is continuing the advocacy work by heading a new venture called Seniors Across America to continue speaking up for our elderly population.


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