VA to cover new Alzheimer’s drug
Eligible veterans will be able to access recently approved treatment
Some veterans will be able to get help affording a new Alzheimer’s treatment.
The VA said it will cover Lecanemab, also known as Leqembi, after it was given accelerated approval by the U.S. Food and Drug Administration in January. It is the first major insurer to announce coverage of the drug.
The decision was made by the VA National Formulary Committee, which operates the pharmacy benefit manager for the VA, according to a statement from Terrence Hayes, a VA press secretary.
“Based on the clinical evidence that was available at the time of the FDA’s accelerated approval, the committee believes that there are potential patients who could benefit from this therapy,” Hayes said. “Therefore, VA chose to allow for use in those patients that most closely align with the clinical trial selection criteria so that therapy would not be delayed.”
Leqembi is a monoclonal antibody meant to treat Alzheimer’s by slowing it. Trials found it “resulted in moderately less decline” in cognition and function compared to the placebo group over 18 months, according to an explanation of the trials in The New England Journal of Medicine.
The VA estimates there are nearly 168,000 veterans enrolled in the VA who have Alzheimer’s dementia, according to data provided by the VA. Alzheimer’s is the most common form of dementia. The Centers for Disease Control and Prevention estimates 5.8 million Americans were living with Alzheimer’s in 2020 and that by 2060, roughly 14 million Americans will have the neurodegenerative disease.
For a VA member to get Lecanemab, they must meet strict criteria, get approval for the drug through the VA formulary and the drug must be specifically requested by a clinician, according to Hayes.
“Each dose of the medication administered for each patient will be tracked and monitored for safety and appropriateness of use, in real time, by VA’s Center for
Medication Safety,” he said.
The VA will pay $195 for a 2mL dose and $587 for a 5mL dose, and veterans with copays will pay $11 to $33 depending on days of supply for outpatient medication, according to the VA copay rates chart. The drug is expected to cost around $26,500 a year, according to the Fisher Center for Alzheimer’s Research Foundation.
Support groups such as the Alzheimer’s Association and Global Alzheimer’s Platform Foundation have praised the decision and said the Centers of Medicare and Medicaid Services, which administers Medicare and Medicaid, should also start covering the drug.
In February, CMS released a statement saying it would continue to look at data as it becomes available from testing trials but at the time of the release, it would not be reconsidering its previous decision to deny coverage of the drug. CMS will start covering the drug to certain extents the same day the drug gets traditional FDA approval, according to the release.