The surprise announcement comes after the Centers for Medicare & Medicaid Services in February said it was not ready to reconsider its highly restrictive Medicare coverage of drugs in this class. 

The VHA will consider potential candidates for Leqembi treatment if they fit the VHA’s criteria for use and the parameters of Food and Drug Administration’s (FDA) current drug label, Eisai said in a statement. 

“The VHA’s careful consideration and timely action to make Leqembi available … shows its continued commitment to veterans living with AD,” the drugmaker said.

Leqembi was approved for use in January for patients with early Alzheimer’s disease. The drug and its predecessor Aduhelm are monoclonal antibodies that target Alzheimer’s brain plaques and were granted fast-tracked approvals based on demonstrated need. Clinical trial data showed that treatment with Leqembi slowed measures of cognition and function by approximately 27% over an 18-month period when compared with a placebo group.

Last year, CMS confined coverage of Biogen’s new drug aducanumab (Aduhelm) and any future drugs in the class to clinical trial participants only, citing concerns about the availability of safety and efficacy data, among other issues. Aduhelm’s costs to Medicare were controversial as well.

CMS has said it may reconsider its coverage stance based on additional clinical trial data, and/or if the FDA later approves such a drug using traditional pathways. Along those lines, Eisai last week was granted priority review of its request to convert the accelerated approval of Leqembi to a traditional approval, potentially setting it up for CMS reconsideration. That could lead to a greater patient access beyond veterans and clinical trial participants. The review is scheduled for July 6.

The Alzheimer’s Association praised the VHA’s action. “Each day matters to someone living with early stage Alzheimer’s when it comes to slowing the progression of this disease, and for our nation’s veterans living with Alzheimer’s, today is a good day,” Joanne Pike, DrPH, Alzheimer’s Association president and CEO, said in a statement.

The organization and other patient advocacy groups have been vocal critics of CMS’s current coverage stance. 

Related articles:

FDA approves new drug Leqembi to treat early Alzheimer’s disease

Patient advocates decry CMS decision on Alzheimer’s drug coverage

Alzheimer’s drug lecanemab (Leqembi) has ‘moderate’ effect on cognitive decline, trial data show

CMS restricts coverage of Alzheimer’s drug Aduhelm to clinical trials

“To sell newspapers and get people to watch television news, the media must focus on disasters and scary news,” said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. He suggested this explains why the July 2 WSJ story focused on the problems in the LTC insurance market, such as skyrocketing premiums and major insurers discontinuing sales. The report says insurers miscalculated how fast medical costs would rise, how many seniors would use their policies and how many beneficiaries would hold onto coverage even without making claims. 

The Journal also cited many disturbing statistics, such as that initial premiums on LTC policies would have been 35% higher if insurers had correctly predicted the low cancellation rate. But it did not include statistics about how many beneficiaries have tapped their policies, Slome pointed out.

In 2012, insurers paid $6.6 billion in claims benefits to 264,000 people, according to Slome. 

“The largest (still open) claim has reached $1.8 million paid over almost 16 years,” Slome stated. “The policy was purchased for $881 annually with premiums paid for three years until the claim began.”

Public insurers as well as private companies have hiked LTC rates and suspended new coverage, which dampened a recent victory for same-sex couples in California who are newly eligible for coverage through the state’s largest public pension fund.

But I’m willing to bet that Jefferson, Madison and Monroe had no idea how far the various branches would grow apart.

According to many handicappers, the Supreme Court is about to give our new health law the big adios. While most of the headlines have focused on how this will affect the players at the adult table — namely docs, hospitals and the insurance companies — there’s still plenty for long-term care operators to lose sleep over.

For starters, the law’s demise would officially end the CLASS Act, which sets aside discretionary long-term care dollars. Another provision establishing accountable care organizations would be at risk. In addition, long-term care operators also would be denied an opportunity to participate in several demonstration and grant programs the law has kick-started.

In other words, it appears the highest court in the land is about to take funding and initiatives away from long-term care operators. So this seems like a somewhat odd time for a Senate committee to hold a hearing on how to possibly enhance funding and initiatives for long-term care.

Yet that is exactly what the Senate Special Committee on Aging did Wednesday. Various experts called for greater federal support, including expanded Medicare and Medicaid coverage, and new delivery platforms. Don’t mean to sound disrespectful, but isn’t that sort of like making a wish list during a tornado?

The good news here is that there’s small fear of collusion between the branches of our government. In fact, it’s pretty clear they live in different worlds.

West Penn Allegheny, a hospital system in western Pennsylvania and Highmark Blue Cross entered into a “capital partnership” in which Highmark will invest up to $475 million in Allegheny. Of course, this is subject to regulatory approval. West Penn has had a tough go of it. Once the mighty Allegheny Health Education and Research Foundation, its bankruptcy gave birth to West Penn and it has never quite recovered.

The goal “is the creation of a more efficient model of health care, one that is outcomes-based, with an “integrated delivery and financing system,” Highmark CEO and President Kenneth Melani told the Pittsburgh Post-Gazette. Sounds like they’re in it for the long haul.

Highmark will be able to appoint 60% of the WPAHS board for the first four years, then all of the board members thereafter,

Then there is UnitedHealth Group, which has been quietly buying medical groups and launching physician management groups throughout the country. In the interest of controlling costs by managing doctors directly, other large insurers, including Humana and WellPoint, have indicated they also will follow suit.

Insurers are looking to position themselves as leaders of accountable care organizations (ACOs) by driving physicians to provide cheaper, more efficient care. OptumHealth, an arm of UnitedHealth Group, plans to sell the services of its more efficient physicians on the open market, potentially to rival health plans, NPR reports.

So here’s a simple question. How long before insurers look to buy the most efficient long-term care provider to add to its ACO? Would you be positioned well for purchase? Would you want to be purchased? This is a trend slowly sneaking up on the industry.

Anthony Cirillo, FACHE, ABC, president of Fast Forward Consulting, is a sought-after speaker, healthcare expert, elder advocate and blogger. He works with long-term care facilities in the area of resident experience and strategic marketing. Anthony is an expert guide for assisted living for about.com. He is the author of “Who Moved My Dentures?” In his spare time, he entertains residents in assisted living and nursing facilities. For more, go to www.4wardfast.com and www.anthonycirillo.com.