By Saul Anuzis
The Biden administration just barred most seniors from accessing new treatments for Alzheimer’s Disease.
The decision doesn’t merely cut off a potential lifeline for the roughly one in 10 Medicare enrollees afflicted with this deadly dementia, it also sets a precedent that should terrify tens of millions of seniors — and their loved ones — battling other diseases, from cancer to diabetes.
The Centers for Medicare & Medicaid Services (CMS) decided only to cover the new Alzheimer’s treatment, aducanumab — approved by the Food and Drug Administration (FDA) — for patients enrolled in its own clinical trials.
This move is unprecedented.
The FDA is staffed with scientists and other medical experts who spend months reviewing reams of clinical data to determine whether experimental medicines are safe and effective enough to warrant approval. New medicines are backed by some of the strongest research in health care.
If FDA scientists and clinicians conclude that a treatment’s benefits outweigh its risks and should be available to American patients, then it should be, full stop. CMS officials are tasked with administering the federal government’s largest insurance programs. The agency’s staffers are not qualified to evaluate a drug’s efficacy and safety — that’s the FDA’s job.
But this time, CMS decided to second-guess the experts at the FDA.
Bureaucrats responsible for administering the $400 billion Medicare program supposedly took issue with the FDA’s rationale for approving the drug on an “accelerated” basis, and claim they want more evidence of its effectiveness before covering it for up to 1.5 million Medicare enrollees with early-stage Alzheimer’s who would otherwise qualify to take it, based on the drug label that the FDA approved.
By the time CMS is done, none of those enrollees will still be in the “early-stage” category.
This sets a dangerous precedent. If CMS realizes it can use this type of procedure to unilaterally ration treatments, it’s unlikely to stop at Alzheimer’s drugs. It could use the same excuses to restrict seniors’ access to all sorts of breakthrough medicines for cancer, multiple sclerosis and dozens of other common, hard-to-treat diseases.
This rationing isn’t merely cold-hearted. It’s also financially short-sighted.
In 2020, Medicare and Medicaid’s direct expenditures on Alzheimer’s care totaled $206 billion. Those costs will exceed $750 billion by 2050, unless scientists develop treatments that can significantly slow the disease.
New treatments that delay the progression of Alzheimer’s could save $220 billion over 5 years, with 60% of those savings going towards Medicare and Medicaid.
Yet research companies will be reluctant to invest in such treatments if CMS refuses to cover the medicines.
Every new treatment is an investment in our future. New medicines drive down long-term costs for our healthcare system and patients. And beyond the financial savings, new treatments could cut the number of people suffering from Alzheimer’s by 42% by 2050.
Investing and approving groundbreaking medical treatment now will mean money and lives saved down the line.
None of these potential victories against Alzheimer’s, cancer, ALS, multiple sclerosis or any other hard-to-treat diseases will come to fruition if CMS continues to veer well outside its lane, and second guesses the authority and expertise of the FDA. Seniors and taxpayers alike will be harmed by CMS’s short-sighted rationing.
Saul Anuzis is president of 60 Plus, the American Association of Senior Citizens.