President Biden has repeatedly pledged to make progress on Alzheimer’s disease. Now, with an FDA-approved drug and another under review, his administration can make good on those promises by fundamentally changing the system of care for this terrible disease.
Writing in the Washington Examiner, Joe Grogan, former White House Domestic Policy Council Director, explains how the Biden administration can leverage new treatments to drive a broader restructuring of our nation’s medical culture and incentives to advance healthy aging. That is, if Medicare grants broader access to them.
We pay for expensive long-term memory care without properly considering how new treatments can reduce the need for and cost of these services. A comprehensive reform of the entire system can unlock the promise of the emerging revolution in Alzheimer’s care. This starts with training primary care doctors to recognize the subtle differences between normal aging and true cognitive impairment. Neurologists and infusion centers must also be educated on the proper deployment of new treatments.
Patients and families play an important role too. Many people assume that nothing can be done to treat the disease, and so they delay getting a diagnosis and brush off symptoms. That’s why it’s estimated that more than half of people with dementia remain undiagnosed.
New treatments are the engine that can power reform, but only if they are broadly accessible. Sadly, the Centers for Medicare and Medicaid Services has taken unprecedented steps to throttle access to the most effective Alzheimer’s treatment ever developed, using a policy never before applied to drugs to restrict coverage.
Under CMS’s new policy, the agency is only willing to grant coverage of new treatments if patient data is submitted to a clinical registry that it approves — even if these treatments have been granted traditional FDA approval. CMS assures the registry is easy to use, but leading neurologists believe this additional administrative requirement will delay and even limit access, particularly in rural and underserved communities.
The agency’s reluctance to expand coverage is partly driven by cost (though a statutory bar prevents it from publicly saying so). But without treatment, a progressive disease affecting over 6 million Americans will continue to heap longer-term Medicaid costs on states.
I’ve worked in the federal budget office and as a health policy leader in the executive branch. It’s an administration’s job to guide individual agencies to see the forest for the trees. Medicare is estimated to spend $157 billion on patients with Alzheimer’s this year. Delaying coverage for treatments by just one year could increase patient and healthcare costs by $31 billion.
CMS is the lynchpin for the system change that can revolutionize Alzheimer’s care. In a positive development, the agency has finally recognized the clinical value of PET scans to diagnose Alzheimer’s disease and proposed expanding access to them. But it took 10 years of generating data to draw this conclusion. We can’t afford to wait that long for new treatments. CMS should reconsider its policy on drug access now, and work with a diverse group of stakeholders — physicians, diagnostic leaders, health systems, budget hawks, and patient groups — to meet this moment.
You can read the piece in full here.