President Biden has just a few weeks left in the White House. Expanding access to health care has been one of his priorities. He can notch one more win on that front by directing Medicare to provide unrestricted coverage of novel treatments proven to slow the progression of Alzheimer's disease.
Nearly 7 million people are living with Alzheimer's. By 2050, that figure is expected to double.
Americans care deeply about those suffering from the disease. More than 60% of voters report that a family member or friend has Alzheimer's or some other form of dementia.
It's no surprise, then, that an overwhelming majority of voters believes that Medicare and other insurers should provide coverage of treatments approved by the Food and Drug Administration that can slow the progression of Alzheimer's.
Right now, that isn't happening. In April 2022, Medicare began limiting coverage for a new class of Alzheimer's therapies under a policy known as coverage with evidence development, or CED. The policy effectively bars beneficiaries from accessing these medicines -- which include monoclonal antibodies sold under the brand names Leqembi and Kisunla -- unless they participate in a clinical trial. CED also requires healthcare facilities to meet strict requirements in order to conduct those trials.
Medicare covers FDA-approved treatments for every other disease. So its restrictions on access to these Alzheimer's therapies are unprecedented.
Medicare isn't the only insurer that has put barriers between patients and these drugs. TRICARE, the government health plan for active-duty service members and their families, has refused to cover them at all. Some commercial insurers, such as Highmark, have similarly balked at covering them.
Restricting access to these therapies harms not just those suffering from early Alzheimer's but their families, too.
More than one-third of Americans say they've cared for someone with Alzheimer's or another dementia. In 2023, caregivers spent a total of 18.4 billion hours engaging in unpaid work assisting and caring for people with Alzheimer's. That's about 31 hours spent by each caregiver, every single week. It's no wonder that caregivers suffer from high levels of exhaustion, anxiety, and depression.
These drugs could give families quality extra years with their loved ones before Alzheimer's sets in. They could also delay the need for caregiving -- to the benefit of patients and family members alike.
Depriving people with Alzheimer's and their families of revolutionary new treatments isn't just cruel. It's wildly unpopular. More than nine in ten voters believe Medicare should provide beneficiaries access to Alzheimer's medications just as it covers FDA-approved medications for other diseases.
Nearly seven in ten say that Medicare and other insurers should have to cover the costs of these drugs without requiring physicians and patients to participate in clinical research.
Voters are even willing to pay higher premiums if it guarantees that insurers will cover these Alzheimer's drugs. Nearly three-quarters said they'd pay $5 more a month for health insurance to cover FDA-approved drugs and therapies that can slow the progression of the disease.
November is National Family Caregivers Month. Guaranteeing Medicare beneficiaries access to FDA-approved therapies for Alzheimer's would be a fitting way for the Biden administration to commemorate the occasion, meet the needs of a vulnerable group of patients and caregivers, and bolster its healthcare legacy.
Marvell Adams Jr. is the Chief Executive Officer of Caregiver Action Network and Ken Thorpe is the Chair of Partnership to Fight Chronic Disease.
