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.