Some private insurers are balking at paying for the first drug fully approved to slow mental decline in Alzheimer's patients.
Insurers selling coverage in North Carolina, Pennsylvania and New York, among other states, told The Associated Press they won't cover Leqembi with insurance offered on the individual market and through employers because they still see the $26,000-a-year drug as experimental.
Alzheimer's mainly affects the elderly. About 76% of the people taking Leqembi will be covered by Medicare, according to the Japanese drugmaker Eisai, which developed the drug and is co-marketing it with Cambridge, Massachusetts-based Biogen Inc. Independence Blue Cross made its decision after reviewing published, peer-reviewed studies and publicly available FDA materials.
Because Medicare covers the drug, patients with privately run Medicare Advantage plans will receive coverage, said Juliette Cubanski, of the non-profit KFF, which researches health care issues.Listen now and subscribe: Apple Podcasts | Google Podcasts | Spotify | Stitcher | RSS Feed | Omny Studio Most insurers will probably cover the drug but heavily restrict its use through things like requiring pre-approval, said Greg Warren, a health actuary and member of the Society of Actuaries.
The denials for Leqembi don't surprise Jack Hoadley, a health policy researcher with Georgetown University's Center on Health Insurance Reforms.
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