How a handful of medication are putting pressure on Medicare

Medicare expects to spend one other $550 million this yr on the controversial anti-Alzheimer’s drug Leqembi and predicts the price will rise to $3.5 billion in 2025. accordingly Statistical news. The program spent $5.7 billion in 2022 on drugs like Ozempic and Mounjaro. in keeping with the Kaiser Family Foundation. These GLP-1 drugs were developed to treat type 2 diabetes, but are increasingly getting used to shed pounds by people without the condition.

And those costs are more likely to skyrocket in the approaching years. Medicare agreed to loosen up rules on payment for some GLP-1 drugs if a patient is susceptible to heart disease. And while concerns about advantages and risks have slowed Leqembi’s acceptance, aggressive marketing combined with efforts to significantly increase the variety of Americans diagnosed with Alzheimer’s could significantly increase demand for Leqembi and similar monoclonal antibody drugs.

10 billion US dollars annually

Add all of it up and Medicare will soon spend over $10 billion on only a handful of medication. Ultimately, either taxpayers or beneficiaries who pay higher premiums need to foot the bill.

We have already seen how. In 2021, Medicare increased Part B premiums by an unusually high 15%, largely resulting from the expected launch of the anti-Alzheimer’s drug Aduhelm. After Medicare decided it would not cover the drug most often, it became reduced his Part B premium.

Medicare costs for Leqembi, priced at $26,500 per yr, will range from about $2.7 billion whether it is taken by 1.5% of those eligible to take the drug by at nearly $18 billion if 10% take the drug. said the independent political research group KFF.

But two initiatives could raise those costs significantly, with little profit and a few risk for a lot of patients.

Further diagnoses

First, the Alzheimer’s Association is committed to increasing the number of individuals diagnosed with the disease. This would come with individuals with high levels of certain proteins within the brain, even in the event that they don’t have any symptoms of illness. This could increase the number of individuals diagnosed with Alzheimer’s by 3 million, potentially making them eligible for these latest drug therapies. And Medicare costs proceed to rise.

These latest standards are problematic because weak connection between the formation of the protein, called amyloid beta, and future Alzheimer’s symptoms. The presence of those biomarkers actually increases the danger of Alzheimer’s disease. But while most individuals with mild cognitive impairment are found to have the protein, as much as 30 percent don’t do thatT. Likewise, many older adults with high levels of amyloid beta never experience memory loss or other symptoms.

Despite these shortcomings Blood tests that measure amyloid beta or a related protein called tau come onto the market. While these tests can discover these biomarkers, they can’t diagnose Alzheimer’s disease.

Nevertheless, a comprehensive latest definition of Alzheimer’s disease, combined with newly available tests for the biomarkers, will definitely increase patient demand for the emerging drugs.

An echo of the past

In some ways, this pre-Alzheimer’s diagnosis reflects previous experiences with pre-diabetes.

For greater than 4 many years Doctors have diagnosed prediabetes, a condition by which glucose levels are above normal and below the degrees of type 2 diabetes.

But especially in older adults, a pre-diabetes diagnosis is just a rough indicator of the long run type 2 diabetes.

A 2021 study published in JAMA Internal Medicine found that between 29% and 73% of older adults had high glucose levels, depending on the test used. However, the six-year study of three,400 older adults found that only about 9% to 17% of those with prediabetic glucose levels ever developed clinical diabetes.

Doesn’t matter. An increase in pre-diabetes diagnoses most definitely led to a rise within the variety of patients taking weight reduction medications akin to Ozempic.

Here’s why: These drugs cost as much as $11,000 annually, before discounts. While Medicare is prohibited from paying for weight-loss medications, it will possibly cover medications to treat diabetes (which, by the way in which, helps you shed pounds).

You know where that is going. Patients who really need these weight reduction medications “off-label” are diagnosed with pre-diabetes, so Medicare picks up the tab. The same thing can now occur with heart disease.

Benefits of testing, but…

Early testing can have vital advantages. Early diagnosis of problematic glucose levels is usually a signal that patients should change their food regimen or exercise more to stave off serious illness. Previous evidence of high cholesterol can reduce the danger of heart disease or stroke. Likewise, tests can detect very early, presymptomatic cancers that will be more easily treated.

But pre-diabetes and pre-Alzheimer’s are different because, no less than today, most tests are uncertain indicators of future disease.

Alzheimer’s drugs remain problematic. The diabetes/weight reduction medications can have real advantages, although we do not yet learn about their long-term effects. Still, you do not have to be a cynic to imagine that that is one in every of the motivations for early diagnosis is driven by money, especially when the connection between test results and serious illness is so tenuous. And the worth might be paid by Medicare recipients and taxpayers.