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Expand chart
Reproduced from KFF and Bernstein; Chart: Axios Visuals

Biogen's new Alzheimer's treatment could be experts' nightmare drug spending scenario: An extremely expensive product that millions of desperate patients could be eligible for — and it may not even work.

Why it matters: Alzheimer's is a devastatingly common disease with no cure. But the FDA's decision this week paved the way for a free-for-all in which taxpayers foot most of the enormous bill for a drug that hasn't been proven effective.

Driving the news: The FDA approved Aduhelm for all Alzheimer's patients, rather than the narrower subset it was tested against.

  • It's estimated that around 6 million Americans currently have the disease, most of whom are covered by Medicare.

By the numbers: Around 500,000 Americans are diagnosed with Alzheimer's each year, and the company announced that the drug costs $56,000 annually.

  • Patients would receive monthly infusions of the drug, which they'd likely need long-term. An Alzheimer's patient lives, on average, an additional three to 11 years after their diagnosis, per the Mayo Clinic.
  • If half of the newly eligible Americans in a year began treatment with Aduhelm, the cost would be $14 billion — roughly equivalent to Medicare Part B spending in 2019 on the next 8 products combined, per a Bernstein analysis. Total Part B spending in 2019 was $37 billion.
  • But that's a conservative estimate of annual spending on Aduhelm, as it only applies to half of one year's worth of newly diagnosed Alzheimer's patients.

Yes, but: It will likely take a while for the health system to build up enough capacity to handle the influx of eligible patients.

  • And some private insurers may limit eligibility. Steve Miller, chief clinical officer at Cigna, said yesterday that he expected Cigna and most other insurers will pay for the drug only for patients meeting certain criteria, per the NYT.

Between the lines: The numbers alone could give new ammunition to advocates who argue that drug prices are too high and should be limited.

  • "It's unconscionable to ask seniors and taxpayers to pay $56,000 a year for a drug that has yet to be proven effective. Medicare must be able to negotiate a fair price for prescription drugs," tweeted Senate Finance Committee Chairman Ron Wyden.
  • But politicians may find it hard to take on the narrative that the treatment is anything but a long-sought beacon of hope for Alzheimer's patients.

What they're saying: “It’s always been the worry that if you get a super expensive drug that is targeted toward a huge population, that that is going to be a turning point in how we deal with health care spending," said Walid Gellad, a health policy professor at the University of Pittsburgh. "And that’s what this drug is.”

Go deeper: Aduhelm's price to squeeze Medicare and patients

Go deeper

Sep 14, 2021 - Health

Medicare to repeal medical device rule pushed by Trump administration

Medicare is rescinding a major medical device rule. Photo: Matt McClain/The Washington Post via Getty Images

The Centers for Medicare & Medicaid Services is proposing to kill a regulation the agency finalized earlier this year under the Trump administration that would have required Medicare to pay for any medical device deemed as a "breakthrough" by the FDA.

Driving the news: After receiving public feedback, CMS determined the rule was "not in the best interest of Medicare beneficiaries because the rule may provide coverage without adequate evidence that the breakthrough device would be a reasonable and necessary treatment."

Updated 2 hours ago - Politics & Policy

Bipartisan tributes flood in for "giant of the Senate" Bob Dole

Then-Vice President Joe Biden and former Sen. Bob Dole at an event put on by the World Food Program where he was awarded the first “McGovern-Dole Leadership Award” in December 2013. Photo: Douglas Graham/CQ Roll Call

Republican and Democratic politicians, including former Senate colleagues, are sharing condolences and memories commemorating the life of Bob Dole, who passed away at 98 on Sunday morning.

The big picture: Dole, the Republican presidential nominee in 1996, was the longest serving Republican leader in the Senate until 2018, when current Senate Minority Leader Mitch McConnell surpassed his record,

Former Sen. Bob Dole dies

Former Sen. Bob Dole in 2019. Photo: Tom Brenner/Getty Images

Former Kansas Sen. Bob Dole passed away Sunday morning at the age of 98, the Elizabeth Dole Foundation announced in a statement.

Driving the news: Dole, a revered figure in U.S. politics and the Republican presidential nominee in 1996, served in the Senate for 27 years, including 11 years as GOP leader. Earlier this year he revealed he had been diagnosed with stage 4 lung cancer.