Title: Private Insurers Refusing Coverage for Breakthrough Alzheimer’s Drug, Leqembi
In a setback for Alzheimer’s patients and their families, private insurers in several U.S. states are declining to cover the cost of Leqembi, the first drug to receive full approval for slowing mental decline in those suffering from the disease. Insurers in North Carolina, Pennsylvania, and New York have deemed the $26,000-per-year drug experimental and are excluding it from individual or employer-offered insurance plans.
While Medicare will ensure coverage for most patients taking Leqembi, despite monitoring its safety and effectiveness, patients under the age of 65 with commercial insurance may face challenges securing coverage. This is particularly concerning since younger individuals, including those in their 30s, are also receiving Alzheimer’s diagnoses and are more likely to rely on commercial insurance.
Leqembi, which has been approved for patients with mild dementia caused by early-stage Alzheimer’s, is the first drug to convincingly demonstrate a delay in cognitive decline associated with the disease. However, the effects of the drug may be too subtle for patients or their families to notice. Eisai, the drug manufacturer, estimates that roughly 76% of patients currently taking Leqembi will be covered by Medicare.
Some private insurers argue that existing evidence does not provide sufficient support regarding the drug’s safety and effectiveness. However, notable exceptions include insurers such as Kaiser Permanente and Elevance Health, who have decided to cover Leqembi. Many other insurers are still considering whether or not to offer coverage, with the majority likely to impose pre-approval processes to restrict its use.
Private insurers’ denial of coverage faces justification challenges as Medicare has already approved coverage for Leqembi. For patients without commercial coverage, there may be hope in receiving coverage through Medicare or state- and federally-funded Medicaid programs. However, delays in receiving treatment can be risky, as patients may no longer qualify for Leqembi as their condition progresses.
It is important to note that the cost of Leqembi does not account for the additional expenses of repeated brain scans to monitor potential side effects. Patients like Bonnie Bortz, who cares for her 38-year-old daughter suffering from early-onset Alzheimer’s, eagerly await coverage to begin treatment.
As private insurers decide whether to cover Leqembi, the access to this groundbreaking drug remains uncertain for many patients. Without coverage, obtaining treatment can become increasingly challenging, potentially preventing the benefits of Leqembi from reaching those in need.
