New vial size could save Medicare millions on Alzheimer’s drug

Medicare could save up to 74% of the money lost from wasted Alzheimer’s drug lecanemab by simply introducing a new bottle size that would reduce the amount of unused drugs thrown away, new research suggests.

The researchers will publish about the research on October 14 in the peer-reviewed JAMA Internal Medicineestimate that Medicare could waste up to $336 million annually due to wasted medications. The doses administered are based on the body weight of each patient. But because the drug is currently only available in single-use 500 mg and 200 mg vials, significant amounts of the expensive drug are wasted when the dose prescribed to a patient is lower than the amount in the vials.

Clinical trials have shown that the drug, intended for people with mild cognitive impairment or mild dementia, has a marginal net clinical benefit. Previous research led by UCLA has suggested that the cost of the drug, plus additional costs such as treating brain swelling related to the medication, could cost Medicare $2 billion to $5 billion a year.

Healthcare costs continue to rise every year, putting significant strain on the Medicare budget, said lead author Frank Zhou, a fourth-year medical student at the David Geffen School of Medicine at UCLA.

It is imperative to reduce spending on services that do not improve patients’ health, and this is a prime example of that, as Medicare pays for a drug only to literally throw some of it away. There are significant opportunities for savings even with this one drug, implying that even greater savings could be achieved if our proposed solutions were applied to other infused therapies.”

Frank Zhou, lead author

Medicare spent $33 billion on Part B infusion drugs in 2021, says Dr. John Mafi, associate professor of medicine in the department of general internal medicine and healthcare research at the David Geffen School of Medicine at UCLA.

“Thus, there is substantial opportunity for cost savings by reducing waste of all infusion medicines,” said Mafi, lead author of the study.

Under the Infrastructure Investment and Jobs Act of 2021, manufacturers are required to reimburse Medicare for waste exceeding 10%, Zhou said. “However, we estimate that lecanemab wastage is only 5.8%, making current policies ineffective and sounding the bell that further policy changes are likely needed,” he said.

Using the nationally representative 2020 Health and Retirement Study, researchers analyzed data from participants aged 65 and older, who had Medicare Part B coverage and were eligible for lecanemab. They calculated each person’s required weight-based dose, subtracted that amount from each patient’s delivered dose to determine how much would be thrown away, and then multiplied that amount by the number of doses per year to estimate the annual amount wasted .

For example, a 65 kg patient would be prescribed a dose of 650 mg. Since this patient would receive one 500 mg vial and one 200 mg vial, 50 mg would ultimately be discarded.

Assuming a conservative lecanemab uptake rate of 1.1-2.9% for an estimated 82,000 to 208,000 of eligible people, current vial sizes would result in an estimated $133 million to $336 million worth of medications being wasted annually . This means that the discarded lecanemab from 16 patients could provide enough medication for an additional person. The researchers suggest that this waste could be reduced by 74% by adding a third vial of 75 mg without significantly harming the quality of care or risking drug prices rising above inflation.

The cohort the researchers studied may not have the same weight as actual users of lecanemab, expected uptake rates are not accurate, the production and regulatory costs of changing vial sizes are not factored into the findings, and the amount of waste may be underestimated due to the algorithm. used, all of which limit the findings, the researchers note.

Co-authors of the study are Chi-Hong Tseng, Mei Leng, Dr. Benjo Delarmente, Dr. Catherine Sarkisian and Dr. John Mafi of UCLA, and Cheryl Damberg of RAND Corporation.

The study was funded by the National Institute on Aging (R01AG070017-01).