A recent study indicates that Medicare could potentially recover 74% of its losses from wasted Alzheimer’s medication, lecanemab, simply by introducing a new vial size to minimize leftover doses that go unused.
Scheduled for publication on October 14 in the peer-reviewed journal JAMA Internal Medicine, the study’s researchers project that Medicare might be losing as much as $336 million each year due to discarded doses. Since the dosages are tailored to each patient’s body weight, the current single-use vial sizes of 500 mg and 200 mg lead to a significant amount of the costly drug being wasted when a patient’s prescribed dose is smaller than the vial contents.
Clinical trials have shown that lecanemab, which is used for individuals with mild cognitive impairment or mild dementia, offers only a slight clinical improvement. Earlier research from UCLA has estimated that the overall costs, including treatment for brain swelling associated with the drug, could reach anywhere between $2 billion and $5 billion annually for Medicare.
Year after year, healthcare expenses continue to climb, placing a heavy burden on the Medicare budget, according to Frank Zhou, the lead author and a fourth-year medical student at the David Geffen School of Medicine at UCLA.
“It’s crucial to cut down on spending for services that do not enhance patient health. This situation is a clear illustration of that—Medicare is footing the bill for a drug while wasting part of it,” he stated. “There are significant avenues for savings even within this drug, indicating that larger savings may be possible if our proposed changes are applied to other infusion therapies.”
In 2021, Medicare allocated $33 billion for Part B infusion medications, noted Dr. John Mafi, an associate professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
“This highlights a significant opportunity for cost savings by minimizing waste across all infusion drugs,” said Mafi, who is also the senior author of the study.
According to the Infrastructure Investment and Jobs Act of 2021, drug manufacturers must compensate Medicare for waste that exceeds 10%. “However, in our estimates, the waste from lecanemab is only around 5.8%, which makes the current regulations inadequate, indicating the need for further policy revisions,” Zhou explained.
Using data from the nationally representative 2020 Health and Retirement Study, the researchers examined information from participants aged 65 and older who had Medicare Part B and could qualify for lecanemab. They calculated the necessary weight-based dose for each individual, deducted that from the dispensed amount to see how much would be discarded, and then multiplied that volume by the annual number of doses to estimate the total yearly waste.
For example, a patient weighing 65 kg would receive a 650 mg prescription. If provided with one 500 mg vial and one 200 mg vial, 50 mg would be wasted.
With anticipated lecanemab usage rates estimated between 1.1% and 2.9% among approximately 82,000 to 208,000 eligible patients, the current vial sizes could lead to an estimated annual waste of $133 million to $336 million worth of medication. This implies that the lecanemab discarded from just 16 patients could be sufficient for treating one additional patient. The researchers propose that by adding a new 75 mg vial, wasted medication could be reduced by 74% without adversely affecting patient care or triggering a price surge beyond inflation rates.
The researchers acknowledge limitations in their findings, noting that the cohort analyzed may not perfectly represent actual lecanemab users, expected uptake rates are uncertain, manufacturing and regulatory costs related to introducing new vial sizes were not factored in, and the waste amount may have been underestimated based on the algorithm employed.
Co-authors of the study include Chi-Hong Tseng, Mei Leng, Dr. Benjo Delarmente, Dr. Catherine Sarkisian, Dr. John Mafi from UCLA, and Cheryl Damberg from RAND Corporation.
This research received funding from the National Institute on Aging (R01AG070017-01).
