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Prominent Democrat Urges Biden Administration to Reform Medicare Policy

Another prominent Democrat has weighed in on access challenges surrounding new Alzheimer’s treatment. Writing in STAT News First Opinion, former Senate Finance Committee Chair Max Baucus described how Medicare policies are putting diagnosis and treatment out of reach in rural states like Montana, and calls on Democrats to seize the opportunity to lead on this issue.

In 2011, President Obama signed the National Alzheimer’s Project Act into law, establishing a national goal of preventing and effectively treating the disease by 2025. In his 2013 State of the Union address, he laid out a bold vision to fund and accelerate brain research: “If we want to make the best products, we also have to invest in the best ideas. Today, our scientists are mapping the human brain to unlock the answers to Alzheimer’s. Now is the time to reach a level of research and development not seen since the height of the Space Race.”

Today, after more than 150 failed trials, we are finally making progress with new treatments that demonstrate clear clinical benefit for patients and their families. The realization of these discoveries is one small step for man. President Biden can assure that it is a giant leap for mankind.

Leadership is never easy. In 2008, when I was chairman of the U.S. Senate Finance Committee, few believed we could reform our health insurance system to massively expand affordable, high-quality coverage. And for a while, it looked like we couldn’t. But we spent more than a year bringing together voices who disagreed — sometimes ferociously — and forging compromise until we found a system that could work and passed the Affordable Care Act. Today, more than 35 million people have access to health insurance that used to be out of reach.

As medical breakthroughs emerge in specialized care, we must continue to forge a path to swift, affordable coverage for all Americans. Alzheimer’s is among our nation’s greatest unmet medical needs — one that we couldn’t hope to solve with the tools available 15 years ago.

Baucus goes on to explain that Medicare has restricted access not only to FDA-approved medicines, but also to the PET scan technology needed to diagnose Alzheimer’s disease. He calls on the Biden Administration to reform Medicare’s policy and explore new models to expand coverage for Alzheimer’s care.

Now that Leqembi has received traditional FDA approval, a registry is required to access it. This is a step in the right direction, but it still poses a potential administrative burden for providers outside of large, well-resourced health systems.

A similar policy has been applied to PET scans, a brain scanning technology needed to accurately diagnose Alzheimer’s, for the last 10 years. In part due to these requirements, Montana is one of 18 states that doesn’t have a Medicare-approved clinical trial site for PET scans. While the Centers for Medicare and Medicaid Services recently proposed changing some aspects of this policy, the fact remains that Montanans seeking diagnosis and treatment may still have to travel across state lines to obtain coverage for care. This is a tremendous burden on patients suffering from the disease, as well as their families and caregivers who bear the responsibility for travel and adherence to study protocols.

Balancing Montana’s independence with equitable access to care was a unique challenge that I had to grapple with as the state’s representative. In one of the least densely populated states with nearly half of its residents living outside cities, it’s common to travel several hours for routine doctor visits. This inequity may partly explain why twice as many people die with Alzheimer’s in rural versus urban areas.

The policies surrounding Alzheimer’s care need to be addressed in a comprehensive way that creates a path to care for all Americans. As a first step, Medicare should provide coverage without restrictions to FDA-approved treatments and diagnostics for eligible patients. Other avenues to expand access to treatment should be explored as well. At the direction of President Biden, the program has been tasked to evaluate new payment models that account for the entire scope of the disease. This is a prudent and timely call to action. These models should focus on improving overall quality of care, ensuring early and accurate diagnosis and treatment, coordinating follow-up care, and advancing health equity for patients in rural areas.

Baucus was a U.S. senator from Montana for 36 years, and the U.S. ambassador to China from 2014 to 2017. He is among the most influential Democrats to encourage the Biden Administration to change policy on Alzheimer’s care since FDA approved two new treatments. You can read his essay in STAT here.