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ELLEN ANDREWS

Alzheimer’s disease affects six million Americans, stealing memories years before it takes lives. Aduhelm, the first drug intended to treat the Alzheimer’s disease process rather than symptoms, was highly anticipated by patients and families. But it has disappointed on many levels. It isn’t clear that it actually helps patients and troubling side effects are common. But what I find worst is the enormous, unjustified price Biogen is charging for it and the sacrifices necessary to afford it. 

Aduhelm hasn’t delivered on its promises. The FDA’s independent expert advisory committee found that, while there is evidence from clinical trials that the drug reduced plaques in the brains of Alzheimer’s patients, there are doubts whether the drug slowed cognitive decline. Also, over 40% of Alzheimer’s patients who received the drug in clinical trials experienced brain swelling, headaches, dizziness, and small bleeds in the brain. The committee voted overwhelmingly not to approve the drug. When the FDA approved the drug anyway, three members of the committee resigned. 

Setting aside the issue of its questionable efficacy, Biogen has set the price for Aduhelm at $56,000 per year. In addition, the drug must be administered intravenously every month, costing tens of thousands of dollars more for patients and the health system. As most Alzheimer’s patients are over age 65, the brunt of the costs will fall on Medicare’s Part B program. At that price, the cost of the drug for Connecticut’s 80,000 residents with Alzheimer’s would total $4.5 billion this year – and would rise to $5.1 billion by 2025. For context, in 2014 all Connecticut residents’ total prescription drug spending was $5.3 billion. The cost of Aduhelm for one Connecticut patient would fund the cost of assisted living or 43 more hours per week of home health care for that patient. 

The price has attracted widespread criticism. Based on the evidence, ICER, the national leader in value-based pricing, determined that a fair annual price for the drug would be between $2,500 and $8,300. The Alzheimer’s Association called Biogen’s price for the drug “simply unacceptable. For many, this price will pose an insurmountable barrier to access, it complicates and jeopardizes sustainable access to this treatment, and may further deepen issues of health equity. We call on Biogen to change this price.”

Aduhelm’s costs will fall on both Alzheimer’s patients and the entire health system. Aduhelm will cost Medicare beneficiaries with Alzheimer’s $11,500 each year in coinsurance; that is 39% of the average beneficiary’s annual income. Aduhelm’s costs will increase Medicare premiums for all beneficiaries and those with Medigap insurance that covers coinsurance will see their premiums skyrocket. Aduhelm’s extreme price may jeopardize funding for more promising Alzheimer’s drugs that are now in the pipeline.

The only upside of the controversy and the massive financial burden Aduhelm will place on patients and the health system is that it may finally prompt meaningful prescription drug price reform and pharmaceutical company accountability. 

Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.

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