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Illustration: Aïda Amer/Axios

The FDA's approval of Alzheimer's treatment Aduhelm puts physicians in a difficult position: They hold the prescribing power over a drug that most say is unproven. But desperate patients and families may not know or care about the lack of evidence and will want the prescription anyway.

What they're saying: "The public message has to be clear: This is not a cure, and it's not even clear this is going to make substantial changes to someone's disease course," said Sharon Brangman, an Alzheimer's expert and geriatrician at Upstate University Hospital in New York.

By the numbers: Almost 90% of physicians disagree with the FDA's approval of Aduhelm, and roughly 80% said they will not prescribe it, according to a new Medscape survey of doctors.

  • At a minimum, doctors believe the FDA's label for Aduhelm is too broad, and the drug should only be for patients who have mild dementia and who have gotten scans showing they have the sticky brain plaques that the drug removes, according to interviews with doctors.

Yes, but: Patients and their family members have been asking about Aduhelm nonstop since the FDA approval.

  • Brangman says her clinic is fielding visits and calls from 40-60 patients per day, and each patient is asking about the drug.
  • Physicians worry that despite how much they educate people about Aduhelm's unproven benefit, risky side effects, and high price, people will push for the prescription.
  • "My mother-in-law has advanced Alzheimer's. Would I give her this medication? Absolutely not," said Marc Gordon, a neurologist and Alzheimer's researcher at Northwell Health in New York. "But will doctors sometimes feel like they're doing something against their better judgment to appease the wishes of patients and families? Probably."
  • Gordon, who believes the drug's approval will lead to "unrealistic expectations," said one of his colleagues in a private neurology practice got "yelled at by a patient's family because they couldn't get the drug the next day."

The other catch: Physicians and hospitals will have a major financial incentive to prescribe the drug.

  • If Medicare covers Aduhelm, it will fall under Medicare Part B.
  • Medicare adds a 6% markup for all Part B drugs, which has long created concerns that providers are prescribing higher-priced drugs to get higher add-on fees.
  • Aduhelm has a list price of $56,000 per year, which would mean thousands of dollars per patient every year just in Medicare add-on fees.
  • And since hospitals and private equity firms increasingly own neurology clinics, "health systems could see this as a new opportunity to bring in revenue and start advertising their memory care," said Joseph Ross, a Yale University physician and researcher who has criticized Aduhelm's approval.

The bottom line: "[Aduhelm] puts physicians in a much more challenging role of walking patients through what to expect," Ross said.

Go deeper: New Alzheimer's drug is a catastrophe in the making

Go deeper

Updated Oct 7, 2021 - Axios Events

Watch: A conversation on bridging gaps in health access

On Thursday, October 7, Axios health care reporter Marisa Fernandez and managing editor for politics Margaret Talev discussed what’s next for ensuring access to quality health care, featuring Rep. Raul Ruiz and Biotechnology Innovation Organization president and CEO Dr. Michelle McMurry-Heath.

Rep. Raul Ruiz illustrated his community outreach efforts to vaccinate his California constituents, the biggest obstacles to receiving the vaccine in underserved communities, and how he believes issues of health care access extend far beyond the pandemic.

  • On why many of his constituents had not yet received the COVID vaccine: “I can tell you by far, it’s not vaccine hesitancy. It is a lack of resources and know-how and being able to overcome the barriers that already exist in an underserved community with a lack of physicians, a lack of doctors, a lack of resources, clinics, a lack of health education, also in a language that they would understand, a lack of transportation.”
  • On broader lessons to consider for the future of health care: “The other thing that we need to take away from this is that our health care workforce is quite fragile. We saw a lot of the front lines break, not just in terms of the lack of personnel that was available for the enormous amount of hours that were required to take care of the really sick patients, but also the fatigue and the anxiety and the stress and those that got sick and were quarantined or died really made a negative difference during this pandemic.”

Michelle McMurry-Heath explained how the biomedical innovation industry is responding to a lack of equitable health care access, how clinical trials can better reflect diverse populations, and the biggest challenges in access to drug development.

  • On how the biomedical industry is responding to the issue of health care access highlighted by COVID-19: “I think the most important thing to state is that all of the companies are really dedicated to making sure they’re not just working incredibly hard to find vaccines and cures, but that they are working just as hard to make sure that those products reach every patient who needs them. We are not out of this pandemic until everyone around the globe is safe from COVID. We have a lot of work to go before we sleep.”
  • On the lack of representation for minority communities in clinical trials: “If you look at what’s available to physicians today, there are not a lot of clinical options for diseases that are ravaging minority communities like Type 2 diabetes, like heart disease, like stroke. The true answers for disadvantaged communities are still on the research south.”

Axios VP of Communications Yolanda Brignoni hosted a View from the Top segment with Genentech SVP of Access and External Affairs Fritz Bittenbender, who discussed the importance of research efforts focused on improving health care for underserved communities.

  • “We continue to focus there both in terms of clinical trials and trying to diversify our clinical trial base to have more access...but also on the health care policy side, ensuring that any policy that the state, local or federal governments are enacting are thinking about health equity with a significant policy lens when they’re talking about changes to our health care system.”
Updated 5 hours ago - Politics & Policy

Omicron dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Pfizer and Moderna boosters overwhelmingly prevent Omicron hospitalizations, CDC finds — Omicron pushes COVID deaths toward 2,000 per day — The pandemic-proof health care giant.
  2. Vaccines: The case for Operation Warp Speed 2.0 — Starbucks drops worker vaccine or test requirement after SCOTUS ruling — Kids' COVID vaccination rates are particularly low in rural America.
  3. Politics: Biden concedes U.S. should have done more testing — Arizona says it "will not be intimidated" by Biden on anti-mask school policies — Federal judge blocks Biden's vaccine mandate for federal workers.
  4. World: American Airlines flight to London forced to turn around over mask dispute — WHO: COVID health emergency could end this year — Greece imposes vaccine mandate for people 60 and older — Austria approves COVID vaccine mandate for adults.
  5. Variant tracker

Arizona governor sues Biden administration over COVID funds tied to mandates

A teacher prepares a hallway barrier to help students maintain social distancing at John B. Wright Elementary School in Tucson, Arizona, on Aug. 14, 2020. Photo: Cheney Orr/Bloomberg via Getty Images

Arizona Gov. Doug Ducey (R) filed a lawsuit Friday against the Biden administration for ordering the state to stop allocating federal COVID relief funds to schools that don't comply with public health recommendations such as masking, the Arizona Republic reports.

Why it matters: The Treasury Department said last week that the state would have to pay back the money if Ducey does not redesignate the $173 million programs to ensure they don't "undermine efforts to stop the spread of COVID-19."