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Leqembi, the new Alzheimer’s therapy developed by Biogen (NASDAQ:BIIB) and Eisai (OTCPK:ESALF) (OTCPK:ESAIY), could add $2B – $5B costs to Medicare annually, in the event of broader coverage, according to a recently published study.
Early this year, the FDA granted FDA’s accelerated approval for the anti-amyloid antibody, which comes with a $26.5K annual list price and additional costs for administration.
Medicare, the federal health insurance for those aged 65 years or older that caters to most of the 6M Americans with Alzheimer’s, currently covers Leqembi (lecanemab) only for patients enrolled in government-approved clinical trials.
However, the administrator of the program, the U.S. Centers for Medicare and Medicaid Services (CMS) is ready to offer full overage if Biogen (BIIB) and Eisai (OTCPK:ESALF) succeed in getting full FDA approval for the treatment.
With the FDA’s decision on Leqembi’s full approval due in July, the researchers at the University of California, Los Angeles (UCLA) estimated its impact on Medicare using a sample representing nearly 44M of the plan’s beneficiaries.
Researchers assumed Medicare would cover 80% of their annual costs for Leqembi, including the price of the medication and additional treatment costs worth more than $7,300 per patient. Out of more than 7,500 subjects analyzed in the study, 16% were found to have mild cognitive impairment or mild dementia, the approved indications for Leqembi.
According to the study published on Thursday in JAMA Internal Medicine, the researchers found that Medicare would spend $2B annually if about 85,700 patients were eligible for the therapy or $5.1B if about 216,500 became eligible.
Given its list price and additional costs for administration, broader coverage for Leqembi “could increase Medicare spending, possibly leading to beneficiary premium increases,” the researchers wrote.
Last year, a similar analysis by UCLA researchers indicated that Aduhelm, the previous Alzheimer’s drug developed by Biogen (BIIB) and Eisai (OTCPK:ESALF), would lead to $7B – $37B additional costs for Medicare if 25% of patients are eligible to receive it.
Following its approval in 2021, Medicare was weighing a hike in premiums to meet Part B coverage for Aduhelm before taking a step back after the companies agreed to cut its list price to $28,200 per year.
Other Alzheimer’s drug developers include Eli Lilly (LLY), Cassava Sciences (SAVA), Anavex Life Sciences (AVXL), Annovis Bio (ANVS), Alnylam (ALNY), Prothena (PRTA), Alector (ALEC), AC Immune (ACIU), INmune Bio (INMB), Athira Pharma (ATHA) and Roche (OTCQX:RHHBY).
