A recent study suggests that Medicare could significantly reduce waste from the Alzheimer’s drug lecanemab by introducing a new vial size, potentially saving up to 74% of the $336 million lost annually due to discarded medication. The research, published on October 14 in JAMA Internal Medicine, highlights the issue of drug wastage caused by dosage discrepancies and offers a straightforward solution: adding a 75 mg vial to complement the existing 500 mg and 200 mg vials.
Lecanemab, a drug used to treat people with mild cognitive impairment or mild dementia, is currently packaged in single-use vials. Since dosages are based on patients' body weight, the one-size-fits-all packaging leads to significant wastage when the prescribed dose is lower than the vial size. For example, a patient requiring 650 mg would receive one 500 mg and one 200 mg vial, leaving 50 mg of unused and discarded medication.
Lead author Frank Zhou, a medical student at the David Geffen School of Medicine at UCLA, emphasized the urgency of reducing such wasteful spending. “It is imperative to reduce spending on services that do not improve the health of patients, and this is a prime example,” Zhou said, noting that part of the problem is that Medicare is paying for drugs that are quite literally being thrown away.
The study's senior author, Dr. John Mafi, associate professor of medicine at UCLA, noted that Medicare spent $33 billion on Part B infusion drugs in 2021, a category that includes lecanemab. Given that waste from just this one drug could cost hundreds of millions, Mafi believes there is "substantial opportunity for cost savings by reducing waste from all infusion drugs."
The study comes as healthcare costs continue to rise, placing increasing pressure on Medicare’s budget. Medicare is already mandated to seek reimbursements from manufacturers for waste exceeding 10% under the 2021 Infrastructure Investment and Jobs Act. However, the researchers estimate that lecanemab waste is only 5.8%, falling short of the current reimbursement threshold.
The study's findings were based on data from the 2020 Health and Retirement Study, which involved participants aged 65 and older with Medicare Part B coverage. Researchers calculated individual weight-based doses and compared them to the dispensed dose, estimating annual drug waste. The results showed that lecanemab waste could provide treatment for an additional patient for every 16 patients treated under current vial sizing.
While the proposed 75 mg vial would reduce waste by 74%, the researchers acknowledge some limitations in their study. These include potential differences in weight distribution between the study population and actual lecanemab users, uncertain uptake rates, and the exclusion of manufacturing and regulatory costs in the analysis.
The research team includes experts from UCLA and the RAND Corporation, with funding from the National Institute on Aging. The study underscores the need for further policy changes to address drug waste and reduce healthcare costs, potentially opening the door for similar savings across other infusion therapies.
SOURCE: UCLA, news release, Oct. 14, 2024
