If you could learn that you had Alzheimer's disease years before symptoms took hold, would you want to know?
Nearly four in five Americans say they would.
This finding should be a wake-up call for policymakers. We are in a new era of Alzheimer’s care where diagnosis does not have to be followed by a steep decline. Today, new tests can detect markers associated with Alzheimer’s through a simple blood draw. Once armed with a diagnosis, patients can take action to meaningfully slow progression of the disease.
For instance, research has shown that even moderate increases in physical activity can make a big difference. In one study, people with the proteins of Alzheimer’s disease who walked about 5,000 steps per day experienced a seven year delay in the onset of cognitive decline. Patients may also be eligible for anti-amyloid treatments that can slow progression of the disease, especially when instituted early.
Taking action early can prevent the financial mistakes that often accompany cognitive decline, protect retirement savings, allow families to prepare caregiving and legal arrangements before a crisis occurs, and most importantly, lengthen happy, healthy years.
But as it stands, the healthcare system hasn’t evolved to treat Alzheimer’s with urgency, and bad government policy still stands in the way of early diagnosis and treatment that Americans want. Earlier this year, Health and Human Services Secretary Robert F. Kennedy Jr. called it "regulatory malpractice that we don’t have early [Alzheimer’s] screening already,” adding “we now know that early treatment of Alzheimer’s can postpone its onset.”
Secretary Kennedy is right.
As it stands, both Alzheimer’s detection tools and treatments face serious coverage obstacles. While the traditional Medicare program covers blood tests for Alzheimer’s, most Medicare Advantage and commercial plans do not. And none of them cover blood tests used to screen for Alzheimer’s proteins before people have symptoms, as most Americans want.
New treatments, groundbreaking innovations that should be sped to patients, are stuck in bureaucratic red tape. A Medicare policy called Coverage with Evidence Development, or CED, requires patients to enroll in additional registries to receive coverage for treatment. Many smaller hospitals and physician practices lack the staff necessary to participate in these registries, which restricts access for patients in underserved communities.
Worse, by subjecting medicines that are approved by the U.S. Food and Drug Administration to additional scrutiny, Medicare sends a signal to private insurers that they can deny coverage as well. And they do. Many insurers have used CED to classify Alzheimer’s therapies as "investigational/experimental" and deny coverage, despite the FDA deeming the medicines safe and effective.
Getting bad government policies like CED out of the way could open the door to earlier diagnosis on a broad scale and allow patients to take action. That would be a victory not only for patients and families, but for taxpayers.
Medicare spends roughly $174 billion annually caring for patients with Alzheimer's disease, while Medicaid spends another $72 billion. Those numbers are only expected to rise as the number of Americans living with Alzheimer's is projected to double to nearly 14 million by 2060.
Families are vulnerable too. Alzheimer’s costs about $400,000 per family in lifetime care and lost wages, and families shoulder roughly 70% of that burden themselves through out-of-pocket costs and unpaid caregiving. Family caregivers already lose an estimated $8 billion annually in earnings as they reduce work hours or leave the workforce to care for loved ones.
Research from the University of Southern California suggests that providing treatment before symptoms fully emerge could add a full year of life, reduce nursing home stays by nearly two years, and lower medical spending by roughly $48,000 per patient.
Every life extended represents a significant human and economic victory. Voters agree. According to recent Market Institute polling, nearly eight in ten voters say they are more likely to support candidates who prioritize improving access to early detection, diagnosis, and treatment. Ninety-two percent believe earlier detection and treatment can spare families emotional and financial hardship.
The question is no longer whether patients want to know if they have Alzheimer’s. The technology is here and they are ready to use it. The human and economic upside to acting early is clear. It’s Washington that needs to catch up.
Charles Sauer is president of the Market Institute.
