Biden Alzheimer’s policy will deepen socioeconomic inequities

President Biden has always been a supporter of medical patients and lifesaving treatments. For five years he led the Cancer Moonshot program and, in his first year as president, his administration authorized several promising antiviral medications — all at little or no cost to patients. Unfortunately, the Biden administration is taking a different course in the battle against another tragic disease: Alzheimer’s.  

A draft policy by the Centers for Medicare & Medicaid Services (CMS) would severely restrict access to the first new Alzheimer’s treatments in nearly two decades. This flies in the face of Biden’s commitment to advancing equity. Alzheimer’s affects 6 million people in the U.S. each year — more than breast cancer and prostate cancer combined — and disproportionately impacts minority and underserved communities. 

If implemented, the policy will only deepen the inequities that have been exacerbated by the coronavirus pandemic. Instead, CMS should work toward ensuring that more Americans suffering from Alzheimer’s disease can access treatment options. 

The presence of amyloid plaques — deposits in the brain’s grey matter — is one of the early indicators of Alzheimer’s disease. The Food and Drug Administration (FDA) approved aducanumab last year based on trials that conclusively showed the medicine reduced amyloid plaques by up to 71 percent. Several similar treatments are under FDA review. 

Because most people suffering from Alzheimer’s are over 65, CMS decided to establish national rules for covering these new treatments through Medicare. The agency is understandably concerned about the price tag, but the draft policy went way too far by limiting access through Medicare to clinical trial participants in a hospital facility.

The consequences of CMS implementing this decision will be severe, especially for more vulnerable populations. Economically disadvantaged people who live in rural settings without access to reliable transportation or health insurance will face yet another obstacle toward accessing potentially life-changing treatment. 

Furthermore, Black Americans are about two times more likely than whites to have Alzheimer’s and other dementias, but only one-third more likely to have a diagnosis. Hispanic Americans are about 50 percent more likely than non-Hispanic whites to have Alzheimer’s and other dementias, but only 18 percent more likely to be diagnosed.

The ability to fight Alzheimer’s disease should not be restricted or available only to a privileged few. 

The draft policy also states that “the diversity of patients included in each trial must be representative of the national population diagnosed with Alzheimer’s disease.” This is a laudable goal, since Black and Hispanic Americans long have been disadvantaged in clinical trial participation, despite an intense and ongoing public-private effort to increase enrollment. Recent research by the University of Southern California and Gates Ventures found that the situation is even worse with Alzheimer’s; more than 99 percent of eligible patients are never referred to clinical trials. 

While promoting equity in policy is good, investing and doing the hard work to achieve real goals are better. Increased targeted outreach to underserved communities — not only patients, but also family members and caretakers — will raise awareness of diagnosis and treatment options. This should include education about participation in clinical trials, which will ensure more complete representation in new Alzheimer’s research.  

Patient advocacy groups are up in arms over the CMS proposal. They’ve promised to flood the agency with public comments and launch a multifaceted advocacy campaign to challenge the policy and communicate with lawmakers on Capitol Hill. 

CMS will publish the final policy in April, so there is time to reverse course. If the agency listens to patient advocates it can strike the right balance, expanding access while protecting patient safety and ensuring that Medicare dollars are wisely spent.

As a candidate for president, Joe Biden listed racial inequality as one of the “four historic crises” facing our country, calling it “the most compelling call for racial justice since the ’60s.” As president, his actions speak louder than words. Restricting access to treatment for this widespread and deadly disease flies in the face of the promised justice. Let’s hope President Biden’s administration changes course on Alzheimer’s treatments. 

Mario H. Lopez is president of the Hispanic Leadership Fund, a public policy advocacy organization that promotes liberty, opportunity and prosperity for all Americans. Follow him on Twitter @MarioHLopez.