Kaiser Health News: Paying Billions for Controversial Alzheimer’s Drug? How About Funding This Instead?

By Judith Graham, Kaiser Health News, July 6, 2021

If you could invest $56 billion each year in improving health care for older adults, how would you spend it? On a hugely expensive medication with questionable efficacy — or something else?

This isn’t an abstract question. Aduhelm, a new Alzheimer’s drug approved by the Food and Drug Administration last month, could be prescribed to 1 million to 2 million patients a year, even if conservative criteria were used, according to Biogen and Eisai, the companies behind the drug.

The total annual price tag would come to $56 billion if the average list price, $56,000, is applied to the lower end of the companies’ estimate.

That’s a huge sum by any measure — more than the annual budget for the National Institutes of Health (almost $43 billion this year). Yet there’s considerable uncertainty about Aduhelm’s clinical benefits, fueling controversy over its approval. The FDA has acknowledged it’s not clear whether the medication will actually slow the progression of Alzheimer’s disease or by how much.

“This drug raises all kinds of questions about how we think about health and our priorities,” said Dr. Kenneth Covinsky, a geriatrician and professor of medicine at the University of California-San Francisco.

Since most Alzheimer’s patients are older and on Medicare, the medication would become a significant financial burden on the federal government and beneficiaries. Several experts warn that outlays for aducanumab, marketed as Aduhelm, could drive up premiums for Medicare Part B and Medicare supplemental policies and raise out-of-pocket expenses.

A likely additional cost: lost opportunities to invest in other improvements in care for older adults. If Medicare and Medicaid must absorb drug spending of this magnitude, other priorities are less likely to receive attention.

I asked a dozen experts — geriatricians, economists, health policy specialists — how they would spend an extra $56 billion a year. Their answers highlight significant gaps in care for older adults. Here’s some of what they suggested.

Make Medicare more affordable. High out-of-pocket expenses are a growing burden on older adults and discourage many from seeking care, and Dr. David Himmelstein, a distinguished professor of urban public health at Hunter College in New York City, said extra funding could be directed at reducing those costs. “I’d cut Medicare copayments and deductibles. I think that would go a long way toward improving access to care and health outcomes,” he said.

On average, older adults on Medicare spent $5,801 out-of-pocket for health care in 2017 — 36% of the average annual Social Security benefit of $16,104, according to a report last year from AARP. By 2030, out-of-pocket health expenses could consume 50% of average Social Security benefits, KFF predicted in 2018.

Pay for vision, hearing and dental care. Millions of older adults can’t afford hearing, vision and dental care — services that traditional Medicare doesn’t cover. As a result, their quality of life is often negatively affected and they’re at increased risk for cognitive decline, social isolation, falls, infections and depression.

“I’d use the money to help pay for these additional benefits, which have proved very popular with Medicare Advantage members,” said Mark Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School of Business. (Private Medicare Advantage plans, which cover about 24 million people, usually offer some kind of hearing, vision and dental benefits.)

Over 10 years (2020 to 2029), the cost of adding comprehensive hearing, vision and dental benefits to Medicare would be $358 billion, according to the Congressional Budget Office.

Support family caregivers. Nearly 42 million people provide assistance — help with shopping, cooking, paying bills and physical care — to older adults trying to age in place at home. Yet these unpaid caregivers receive little practical support.

Dr. Sharon Inouye, a geriatrician and professor of medicine at Harvard Medical School, suggests investing in paid services in the home to lessen the burden on unpaid caregivers, especially those tending to people with dementia. She would fund more respite care programs that give family caregivers short-term breaks, as well as adult day centers where older adults can socialize and engage in activities. Also, she recommends devoting substantial resources to expanding caregiver training and support and paying caregivers stipends to lessen the financial impact of caregiving. For the most part, Medicare doesn’t cover those services.

“Providing these supports could make a huge difference in people’s lives,” Inouye said.

Strengthen long-term care. Shortages of direct care workers — aides who care for older adults at home and in assisted living facilities, nursing homes, residential facilities and other settings — are a growing problem, made more acute by the coronavirus pandemic. PHI, a research organization that studies the direct care workforce, has estimated that millions of direct care jobs will need to be filled as baby boomers age.

“We could greatly improve the long-term care workforce by paying these workers better and training them better,” said Dr. Joanne Lynn, a geriatrician and policy analyst at Altarum, a research and consulting organization.

Pages: 1 · 2

Relationships and Going Places, Home and Shopping, Money and Computing, Health, Fitness and Style, News and Issues, Culture Watch, Health and Science, Health Links, Home, Money, Moving and Retirement, Issues, Learning, Grandparenting, Senior Women Web, Articles, Sightings, What's New

Kaiser Health News: Paying Billions for Controversial Alzheimer’s Drug? How About Funding This Instead?

By Judith Graham, Kaiser Health News, July 6, 2021

More Articles