New Alzheimer's Drug Approved by FDA, CMS

[somarco]

Medicare has agreed to pay for the Alzheimer's treatment Leqembi, a major turning point for patients who are diagnosed with the early stages of the disease.

Administered twice monthly in a doctors office for up to 18 months

Patients with Original Medicare will pay 20% of the Medicare approved amount . . . those with a Medigap plan generally will not be billed for the 20% balance.

PET scan required to confirm diagnosis and eligibility

You must have a doctor who is participating in a registry that collects information on the tests you've taken as part of your diagnosis, notes whether you are on blood thinners and documents whether you have had side effects from Leqembi.

https://www.cnbc.com/2023/07/08/leqembi-and-medicare-what-patients-and-doctors-should-know.html

 

[somarco]

At this point, Leqembi is not showing up on ANY drug formulary . . .

 

[Agent 0]

At this point, Leqembi is not showing up on ANY drug formulary . . .

The benefits- "...slowed cognitive decline by 27% over 18 months..."

The risk- "...the treatment also carries serious risks of brain swelling and bleeding. In the trial, 13% of patients who received Leqembi had swelling and 14% had bleeding."

The cost- "Eisai has priced Leqembi at $26,500 per year before insurance coverage..."

Maybe this drug is a breakthrough for dementia research but I'm afraid there might be too much hope coming from loved ones of people with middle/ late stages who are thinking this is gonna be a miracle drug.

Any guesses when this should show up on drug formularies? How long does that process usually take for new drugs?

 

[somarco]

too much hope coming from loved ones of people with middle/ late stages who are thinking this is gonna be a miracle drug.

Only approved for EARLY stage dementia . . . at this point if someone wanted the drug for early/late stage they would not be able to get it.

Any guesses when this should show up on drug formularies? How long does that process usually take for new drugs?

Until it is approved for self administered, it won't be on a Part D formulary.

Aricept now available as a generic (donepezil), tier 2 on several PDP's in pill form daily dosage.

And yes, the side effects are disturbing, plus we usually don't know much about effectiveness AND side effects until medications have been distributed in mass over several years.

Pfizer/Moderna side effects are just now showing up for public consumption even though there were early warnings the vax may not be effective for many and unnecessary for under age 50. Exceptions for those with compromised immune systems.

 

[Agent 0]

Only approved for EARLY stage dementia . . . at this point if someone wanted the drug for early/late stage they would not be able to get it.

Yeah, my grandpa made a comment to my mom about getting my grandmother on it (who has had dementia for ~ 3 years and is at least late middle stage) because he doesn't understand that her early stage sailed 2 and a half years ago.

I just feel sorry for others like my grandpa who have watched their loved one fade away and hope that this is a miracle reversal drug.

 

[ValeRosso]

If it is self administered, can't wait to see the Part D pricing on that bad boy.

 

[somarco]

If it is self administered, can't wait to see the Part D pricing on that bad boy.

Might need to use your Platinum card for that . . .

 

[kgmom219]

It's administered in a docs office. Part B.
Thank goodness

 

[DonP]

It's administered in a docs office. Part B.
Thank goodness

In 2025 max out of pocket for part D will be $2k . In 2024 after you hit your troop thats it no 5% catastrophic phase. I saw the first look on some WellCare mapd plans and I noticed some $375 type rx deductibles that weren't there last yr . I bet part D plans premiums will be jacked big and more deductibles . I think we've hit a pt of mapd benefits leveling or failing and bigger yearly premium rises on med sup . Over all inflation hitting health care big

 

[Chazm]

The last time Medicare thought they were going to cover an Alzheimer's drug, part B went up about 14%. Wonder if we can expect roughly the same increase? $187? Maybe not, but I could see a part B premium of $175.