Next year’s Medicare Part B premiums are expected to be announced soon and there is speculation that coverage for another expensive new Alzheimer’s drug could lead to increased monthly costs, echoing what occurred in 2022.
Leqembi received full approval from the Food and Drug Administration (FDA) in July, becoming the second such drug to hit the market after Aduhelm. The drug costs $26,500 per year.
Although it is only approved for patients with mild cognitive impairment or mild dementia who are also confirmed to have a brain plaque called amyloid, the pharmaceutical industry expects Leqembi to be popular.
Although this drug does not cure Alzheimer’s disease, Leqembi is the first drug to demonstrate clinical benefits for patients by slowing the progression of the disease. This is accomplished by targeting and reducing amyloid plaque in the brain, the accumulation of which is linked to cognitive decline.
Leqembis’ maker, Eisai, estimates that about 100,000 people will be eligible to take the drug in the United States by the third year of its availability, and Medicare coverage of the drug is expected to open access. But some say 100,000 people in three years might be a conservative estimate.
Tricia Neuman, KFF’s senior vice president and executive director of its Medicare Policy Program, noted that the exact use of Alzheimer’s drugs among Medicare beneficiaries is not known.
The actual number of patients who could benefit from Leqembi is unclear because it is difficult to accurately estimate how many people with Alzheimer’s disease have mild cases.
The number and proportion of older people who have [Mild Cognitive Impairment] Alzheimer’s disease is currently difficult to estimate because it requires population-based prevalence measures of MCI and Alzheimer’s disease biomarkers, and this line of research is in its infancy, noted the Alzheimer’s Association in its 2023 Alzheimer’s Disease Facts and Figures report.
The criteria for MCI are also different across different studies, further complicating estimations. The Alzheimer’s Association has observed that some studies estimate that 17 percent of people 65 and older have MCI, while others estimate between 8 and 11 percent.
As KFF noted in a report earlier this year, a consumption of 100,000 would account for 1.5 percent of American adults with Alzheimer’s disease, or about 6.5 million people and even that degree of use would make Leqembi the third most expensive drug to be covered by Medicare Part B.
In 2023, the monthly Medicare Part B premium decreased for the first time in 10 years, from $170.10 per month to $164.90.
This decline was preceded by a significant increase in premiums in 2022, of 15%, attributed to Medicare’s coverage of the new Alzheimer’s drug, Aduhelm. The Department of Health and Human Services (HHS) would later determine that the increase due to Aduhlem was overestimated, resulting in a lower premium.
The Medicare Board of Trustees estimated that the Medicare Part B premium for 2024 could be $174.80 in its annual report released this year, an increase of 6%. This change would not be among the highest increases observed in recent years. Neuman noted that the estimate, released six months ago, could change due to many factors separate from Leqembi’s Medicare coverage.
It’s difficult to know exactly how much 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, such as growth in spending for other services like physician and outpatient hospital services and medications administered by doctors, she added.
When reached for comment on when the final Medicare Part B premium for 2024 will be announced, the Centers for Medicare and Medicaid (CMS) said it plans to release this information in the fall.
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