For the 6 million Americans living with Alzheimer’s disease, the wait for treatment options is almost over. Or is it?
More than a half dozen drugs to treat Alzheimer’s disease and its symptoms are in various stages of development and review. The pipeline includes a treatment for slowing functional decline, and another to address dementia-related psychosis. And new antibody treatments will be among the first drugs that treat the underlying disease, not just the symptoms.
In short, the next generation of drugs will offer Alzheimer’s patients a better quality of life – if they can access the medications.
Health plans have a history of imposing barriers to breakthrough treatments. That’s why advocates are speaking up now – ahead of the drugs’ release. Among their greatest concerns:
- Prescriber Restrictions. Insurers sometimes permit only medical specialists to prescribe certain medications. For Alzheimer’s care, this approach could seriously undermine patient access. Primary care physicians are on the front lines of Alzheimer’s care. Meanwhile, geriatricians and neurologists are in short supply. It would be a disservice for insurers to determine that patients must see a specialist to get their prescription.
- New-to-Market Exclusions. Delaying coverage for new medicines has become unfortunately common among insurers. Health plans may put off adding a new medication to the formulary of approved drugs for months, or even until the next plan year. Applying this tactic to new Alzheimer’s drugs would prolong pain and frustration for people who have been waiting years for relief.
- Prior Authorization. Requiring health plan pre-approval before patients can get their physician-prescribed medication, treatment or test is not new. But, the practice has snowballed in recent years and become a cost-saving tactic for insurers. Subjecting new Alzheimer’s drugs to a lengthy pre-approval process disregards physicians’ judgement and undermines patient-centered care.
Insurance companies often use these and other tactics to limit their spending, but the cost of not treating Alzheimer’s disease is also significant. Alzheimer’s and other forms of dementia are anticipated to cost the nation $355 billion in 2021. That figure doesn’t consider losses to quality of life and personal dignity for people living with the progressive disease.
Alzheimer’s patients and their caregivers have waited long enough and health plans shouldn’t prolong their pain by putting delay tactics into place for new medications.
