The Centers for Medicare & Medicaid Services (CMS) is expecting outlays on Alzheimer's disease drug Leqembi that far outpace the drugmaker's estimates next year.
In a document (PDF) recapping a February stakeholder call that was first obtained by Stat, the agency estimates that per member per month spending on Leqembi will rise from $1.67 in 2024 to $4.67 in 2025. Stat reported that this translates to about $550 million in spending for traditional Medicare this year and $3.5 billion across all of Medicare in 2025.
Based on these projections, that would represent a major jump in spending on Leqembi next year, according to the report. The numbers also raise questions on how much the program should be willing to pay on products like this.
“I think CMS’ estimates demonstrate an incredible demand for Alzheimer’s treatments and possibly suggest broader use than I think was originally conceived,” said Ameet Sarpatwari, Ph.D., an assistant professor of medicine at Harvard Medical School who studies pharmaceutical costs and outcomes, told Stat.
Leqembi, manufactured by Eisai and Biogen, earned a full approval from the Food and Drug Administration in July 2023. With that level of approval, it was able to move past CMS' restrictive coverage determination on this class of drugs, which were rolled out following Leqembi's failed, controversial predecessor, Aduhelm.
At the time, industry watchers express concern about the impact additional coverage for Leqembi could have on costs in Medicare.
In March, Eisai projected that Leqembi would bring in about $2 billion in revenue for 2026.