It is anticipated that the announcement of next year’s Medicare Part B premiums will be made soon, and there is speculation that the coverage of another expensive new Alzheimer’s medication, Leqembi, could lead to an increase in monthly costs, similar to what happened in 2022.
In July, Leqembi received full approval from the Food and Drug Administration (FDA), making it the second drug of its kind to enter the market after Aduhelm. This medication comes with an annual cost of $26,500.
Although Leqembi is only approved for patients with mild cognitive impairment or mild dementia with confirmed amyloid brain plaque, the pharmaceutical industry expects it to be widely used.
While Leqembi is not a cure for Alzheimer’s disease, it is the first drug to demonstrate clinical benefits by slowing down the progression of the disease. It achieves this by targeting and reducing amyloid plaque in the brain, which is associated with cognitive decline.
The manufacturer of Leqembi, Eisai estimates that about 100,000 people in the U.S. will be eligible to take the drug by its third year of availability, and Medicare’s coverage of the drug should increase access to it. However, some suggest that this estimate of 100,000 in three years may be conservative.
Tricia Neuman, KFF senior vice president and executive director for its program on Medicare policy, acknowledged the lack of precise data on the usage of Alzheimer’s medications among Medicare beneficiaries.
The actual number of patients who could benefit from Leqembi is unclear due to difficulties in accurately estimating the mild cases of Alzheimer’s disease. According to the Alzheimer’s Association’s 2023 Alzheimer’s Disease Facts and Figures report, “The number and proportion of older adults who have [Mild Cognitive Impairment] due to Alzheimer’s disease is currently difficult to estimate because they require population-based prevalence measures of MCI and Alzheimer’s biomarkers, and this line of research is in its infancy.”
Furthermore, the criteria for determining mild cognitive impairment vary across different studies, making estimates even more complicated. The Alzheimer’s Association points out that some studies estimate MCI prevalence to be 17 percent among people aged 65 and older, while others put the range at 8 to 11 percent.
According to a report by KFF earlier this year, if 100,000 people were to use Leqembi, it would represent 1.5 percent of U.S. adults with Alzheimer’s, which is an estimated 6.5 million people. Even at this level of usage, Leqembi would be the third most expensive drug covered by Medicare Part B.
In 2023, the monthly premium for Medicare Part B decreased for the first time in 10 years, dropping from $170.10 to $164.90 per month.
This decrease followed a significant premium hike of 15 percent in 2022, which was attributed to Medicare’s coverage of the new Alzheimer’s drug Aduhelm. The Department of Health and Human Services (HHS) later determined that the increase due to Aduhlem had been overestimated, leading to the premium reduction.
In its annual report released this year, the Medicare Board of Trustees estimated that the Medicare Part B premium for 2024 could be $174.80, indicating a 6 percent increase. However, this change would not be among the highest jumps observed in recent years. Neuman emphasized that the estimate, which was released six months ago, could be influenced by various factors unrelated to Medicare’s coverage of Leqembi.
“It’s difficult to know exactly what the Part B premium will be in 2024 or how it will be influenced by any given drug, including Leqembi,” Neuman said.
“The Part B premium is influenced by a number of factors, like growth in spending for other services such as physician services and hospital outpatient services, as well as the drugs administered by physicians,” she added.
When asked about the announcement date for the final Medicare Part B premium for 2024, the Centers for Medicare and Medicaid (CMS) stated that it expects to release that information in the fall.
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