Significant Disparities in Alzheimer's Infusion Therapy Access Raise Alarm

Recent research underscores stark disparities in the adoption of lecanemab, a groundbreaking infusion treatment for Alzheimer's disease. While its approval in July 2023 marked a significant milestone—being the first to receive broad Medicare coverage—its utilization remains uneven across different demographic groups. The study, published in JAMA Network Open, analyzed Medicare fee-for-service beneficiaries between July 2023 and March 2024, revealing that the treatment was predominantly accessed by white, male, urban residents with higher socioeconomic status. Specifically, 90.5% of lecanemab users were white compared to 82% of the general Alzheimer's or MCI population, and nearly 99% of users had higher socioeconomic standing.

The findings show that lecanemab uptake was 6 times higher among white patients versus Black patients, and 24 times higher among those with higher socioeconomic status compared to lower. Male patients and urban residents also experienced higher usage rates. These disparities highlight ongoing issues of inequity in access to advanced therapies for vulnerable populations.

Lecanemab’s effectiveness and safety remain debated within the medical community due to its limited impact on slowing cognitive decline and serious side effects like brain bleeding. The high cost, at around $26,000 annually plus additional expenses, further complicates equitable access. Experts emphasize that despite patient assistance programs, financial and systemic barriers persist.

Medical researcher Frank Zhou of UCLA comments that the significant gaps in treatment access reflect broader systemic inequities. “While the drug’s cost and testing requirements contribute, they also underscore historical patterns of unequal healthcare distribution in the U.S.” The study’s limitations include unavailable Medicare Advantage data and diagnostic challenges, which may underestimate or misclassify cases.

Policy makers are urged to consider real-world data to evaluate ongoing coverage, especially given the modest benefits and safety concerns. As new therapies develop, ensuring fair access for all patients who could benefit becomes increasingly vital, the authors conclude.