OP-ED: Medicare doesn’t want to pay for people with Alzheimer’s

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Medicare doesn’t want to pay for people with Alzheimer’s

By Sue Peschin, MHS

Medicare recently announced it will effectively refuse to cover Aduhelm, the first FDA-approved Alzheimer’s disease treatment in two decades.

For years, the program has gotten away with paying only a fraction of the costs for this disease that impacts more than six million Americans. And by finalizing this restrictive coverage policy, federal officials intend to keep it that way.

Currently, Medicare pays just 16 percent of lifetime costs for a person with Alzheimer’s. The price tag for Medicare is so low because, without treatments, expenses are primarily for non-medical services, such as at-home help with bathing.

The first signal that Medicare would likely limit access to the new treatment was in its August 2021 Board of Trustees report to Congress, which stated, “The scope of Medicare coverage for this drug [Aduhelm] is unknown...Because of these uncertainties, actual program experience could be worse than projected in the high-cost scenario.”

In January 2022, the “scope” of Medicare’s coverage plan to contain expenses for Aduhelm became clear. The agency released a draft Medicare National Coverage Determination requiring “coverage with evidence development” (CED).

Under CED, Medicare covers FDA-approved treatments on a very limited basis, and under the condition that beneficiaries must enroll in a clinical trial or patient registry.

In the agency’s final Medicare coverage policy, the CED requirements vary depending on how an Alzheimer’s treatment is approved by the FDA. If the FDA approves a therapy under “accelerated approval”—a pathway designed to give patients earlier access to medicines that are likely, though not yet fully proven, to be clinically beneficial— Medicare will require beneficiaries with Alzheimer’s to enroll in randomized control clinical trials. Such studies will take years to complete, and patients will have to risk receiving a placebo rather than treatment.

For drugs approved under the FDA’s traditional pathway, Medicare will require beneficiaries to enroll in a patient registry.

The idea of a mandated patient registry may sound good on paper. But in practice, these types of registries have historically exacerbated health disparities.

In reality, Medicare is using CED as a rationing tool to deny expensive care to people suffering from Alzheimer’s. Many patients with the disease are dually eligible for Medicare and Medicaid, and this decision goes out of its way to be especially harsh on them. The likelihood that any full-benefit dually eligible beneficiaries will be able to access these FDA-approved treatments is extremely low.

The impact of this final decision will be felt far beyond Alzheimer’s patients and their caregivers. Federal officials will be able to use it as a precedent to further undermine FDA’s authority and restrict access to future drugs for other serious and life-threatening conditions.

Our older family members and neighbors paid into Medicare to provide care for those before them. We should honor their contributions by ensuring they now receive the coverage they deserve. ■

Sue Peschin, MHS, is president and CEO of Alliance for Aging Research in Washington, DC. This piece originally ran in the Fresno Bee.

The foot bone’s connected to the leg bone; the leg bone’s connected to the hip bone; the hip bone’s connected to the back bone…

~ Dem Bones

When it comes to integrative medicine and understanding your health, these song lyrics couldn’t be truer. That’s because housed within the bones of your spine is a network of nerve fibers that control every bodily function. When there is no interference, your body controls the healthy function of virtually every cell, tissue, organ and system of your body. Any damage or misalignment of your bones can affect your body’s ability to function normally. At Compass Medical Center, we take a whole-body approach to your health and well-being. Our team of highly trained professionals examines the whole body to discover the underlying causes of your health issues and understand why and where it might be dysfunctioning, instead of simply treating your symptoms. We combine the best in the profession with chiropractic, massage therapy, medical services and rehabilitation to provide traditional and alternative therapies all under one roof.

AREA/PART OF BODY POSSIBLE SYMPTOMS

C1 Scalp, face, brain, ear, sympathetic nervous system Headaches, nervousness, insomnia, head colds, high blood pressure, migraines, amnesia, chronic tiredness, dizziness

C2 Eyes, ears, sinuses C3 Cheeks, ears, face, teeth C4 Nose, lips, mouth C5 Vocal cords, neck glands, pharnyx C6 Neck muscles, shoulders, tonsils C7 Thyroid gland, shoulders, elbows T1 Lower arms, hands, esophagus and trachea T2 Heart Sinuses, allergies, pain around the eyes, earaches, fainting spells acne or pimples, eczema Hay fever, runny nose, hearing loss Laryngitis, hoarseness, throat conditions such as sore throat Stiff neck, upper arm pain, tonsillitis, chronic cough colds, thyroid conditions Asthma, cough, difficult breathing, shortness of breath, pain in lower arms and hands Functional heart conditions and certain chest conditions

T3 Lungs, chest, breast

T5 Liver, solar plexus, circulation

T6 Stomach

T7 Pancreas

T8 Spleen

T9 Adrenal and suprarenal glands

T10 Kidneys

T11 Kidneys, ureters

T12 Small intestines, lymp circulation

L1 Large intestines

L2 Appendix, abdomen, upper leg

L3 Sex organs, uterus, bladder, knees

L5 Lower legs, ankles, feet Sacral Hip bones, buttocks bronchitis, pneumonia, congestion, influenza Liver conditions, fevers, blood pressure problems, poor circulation Stomach troubles, nervous stomach, indigestion, heartburn. Ulcers, gas Lowered resistance Allergies, hives Kidney troubles, hardening of the arteries, chronic tiredness Skin conditions such as acne, pimples, eczema Rheumatism, gas pains, certain types of sterility Constipation, colitis, dysentery, diarrhea, some ruptures or hernias Cramps, difficult breathing, minor varicose veins Bladder issues, cramps and irregular periods, miscarriages, knee pain Poor circulation in the legs, swollen ankles, weak ankles and arches Sacroiliac conditions, spinal curvature

Do you have frequent headaches and allergies?

There could be a problem with your upper spine.

Do you suffer from recurrent heartburn?

We’ll take a closer look at the middle of your spine.

Irritated bowels?

Your lower spine could be to blame.

First, you’ll meet with our highly trained case manager to discuss your health history, symptoms, and prior treatments. Our medical team will perform an exam to address your condition using digital X-rays and other diagnostic tools onsite in our Grand Junction office. X-rays help us see the level of degeneration and positioning of the bones which affects how the brain and body communicate. Chiropractors provide adjustments to help bones align and take pressure off of the nerves, so the body can communicate clearly with the brain. Rehabilitation, manual therapy, stimulation and other modalities help strengthen the muscles around the spine and joints. Our medical team offers different types of injections to decrease inflammation and spasm, and to lubricate damaged joints.