- Medicare agrees to financially cover Leqembi, a novel Alzheimer's treatment shown to slow cognitive decline in early-stage patients.
- Despite Medicare coverage, patients could still incur significant out-of-pocket costs, potentially burdening lower-income individuals.
- Conditions for coverage include a confirmed diagnosis, Medicare enrollment, and doctor participation in a patient registry system.
In a game-changing decision for Alzheimer's patients, Medicare has given its nod to the financial coverage of the revolutionary treatment, Leqembi. Leqembi has gained traction as the sole contender in the pharmaceutical market that, based on clinical trials, shows promising signs of slowing early-stage Alzheimer's progression.
The origin of this groundbreaking monoclonal antibody can be traced back to the labs of Japanese pharmaceutical giant Eisai and its partner Biogen, based in the heart of Cambridge, Massachusetts. Administered bi-monthly through intravenous means, Leqembi has demonstrated a 27% deceleration of cognitive decline over 18 months in clinical trials.
The decision from Medicare comes in the immediate wake of the Food and Drug Administration's full approval of the drug. With this coverage, the door of treatment accessibility swings open wider for patients. The move is especially crucial considering Leqembi’s hefty annual price tag of $26,500 before insurance, a price almost at par with Medicare patients' median income.
However, patients won't entirely escape the financial hit. Medicare's commitment to foot the majority of the bill still leaves patients responsible for a substantial part of the costs. Patients enrolled in traditional Medicare will still need to chip in 20% of the Leqembi bill, which could result in an annual cost exceeding $5,000.
The financial impact could be particularly concerning for individuals with lower incomes, a population that includes a high percentage of Black and Hispanic people who are also more at risk for Alzheimer's. Medicare's conditions for Leqembi coverage, which include enrollment in Medicare, diagnosis of mild cognitive impairment or mild Alzheimer's, and doctor participation in a registry, could also present barriers to treatment accessibility.
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