New Alzheimer drug

The Food and Drug Administration (FDA) recently approved use of a new drug -- Aduhelm or aducanumab developed by Biogen -- for treating Alzheimer’s disease. 

Three medical experts on an FDA advisory panel resigned from the panel after deciding the drug's effectiveness has not been sufficiently shown or that the drug will do more harm than good. Link.

The financial effect of the approval on Medicare and Medicare Advantage programs and beneficiaries will be huge. Only time will tell how huge. Medicare’s long-standing practice is to make coverage determinations without taking cost into consideration.  This article from the Kaiser Foundation puts an expected price tag on the drug of $56,000 per patient per year. Since the drug will be physician-administered, it will be covered by Medicare Part B, for which Medicare covers 80% of the cost and the patient 20% (up to the annual out-of-pocket maximum of $7,550 for in-network care and $11,300 for combined in-network and out-of-network care in 2021).

"[T]he drug’s approval could trigger hundreds of billions of dollars of new government spending, all without a vote in Congress or indeed any public debate over the drug’s value." "If even one-third of the estimated 6 million people with Alzheimer’s in the United States receives the new treatment, health-care spending could swell by $112 billion annually." (The Atlantic).

Social Security, Medicare, and Medicaid are sacred cows to politicians and more than half of federal government spending. 

Battling Alzheimer's

Forbes magazine has an interesting article about efforts to fine a cure for and treat Alzheimer's disease. The main points are:
- Bill Gates recently vowed to donate more than $50 million to fund Alzheimer’s research.
- Gates and the Rand Corporation both say that due to the aging of the population, the population of Alzheimer’s patients is growing so rapidly the healthcare system isn’t equipped to handle it.
- Some drug companies such as Biogen and Merck are working on cures. Biogen has a drug undergoing Phase 3 clinical testing expected to be complete in late 2019. Ditto for Merck except 2020. This page describes the different phases of clinical testing (Step 4 section).
- A PET scan is required to diagnose whether or not a person has Alzheimer's. The current supply of PET scan machines and geriatricians capable of diagnosing the results are low compared to the number of people who could be suspected of having Alzheimer's in the next 20 years or so. Thus Gates' and the Rand Corporation's concern about demand much greater than supply.
- The notion that amyloid is the main culprit in Alzheimer’s has come under question recently. Gates will support efforts to look beyond amyloid, investing his money in the Dementia Discovery Fund, which seeds companies pursuing much different theories about what drives the disease.

Still, there are other forms of dementia. Wikipedia says that Alzheimer's is the most common form, being 50-70% of the cases. Dementia also appears in late stages of Parkinson's disease. Forecasts of the number of people with Parkinson's disease also are high. Science Daily reports that new research shows that the number will soon grow to pandemic proportions.