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Alzheimer’s drug Leqembi can be seen in this undated handout picture obtained by Reuters on January 20, 2023.

Eisai | via Reuters

Medicare has agreed to fund Leqembi’s Alzheimer’s treatment, a major game-changer for patients diagnosed with the disease in its early stages.

Leqembi is currently the only drug on the market that has been shown in a clinical study to slow the progression of early stages of Alzheimer’s disease. The monoclonal antibody, given intravenously twice a month, slowed cognitive decline by 27% over an 18-month period in the study.

Leqembi is made by Japanese drugmaker Eisai and its partner biogenicbased in Cambridge, Massachusetts.

Medicare’s decision to acquire Leqembi, which came shortly after the drug was fully approved by the Food and Drug Administration on Thursday, promises to make the treatment more accessible to patients.

For most patients, Medicare coverage is critical to being able to afford Leqembi at all. Eisai has priced Leqembi before insurance coverage at $26,500 per year, which is prohibitively expensive for Medicare patients, who have an average income of about $30,000.

Medicare covers most of the bill, though many patients still face thousands of dollars in out-of-pocket expenses.

According to the Federal Centers for Medicare and Medicaid Services, patients with traditional Medicare coverage pay 20% of the bill for Leqembi. That means these patients could be billed more than $5,000 annually, according to an estimate by KFF, a nonprofit group that studies healthcare issues.

People with Medicare Advantage plans also typically pay 20% for drugs like Leqembi, up to their maximum deductible, which the KFF said averaged about $5,000 for on-net services.

According to the KFF, patients with supplementary insurance such as Medigap or Medicaid may pay less.

People of modest means might not be able to afford the cost of Leqembi even with Medicare insurance, said Tricia Neuman, Medicare expert at KFF.

This is of particular concern because black and Hispanic people are at higher risk for Alzheimer’s disease but are also more likely to have lower incomes, Neuman said.

When demand for Leqembi is high, there are also concerns that patients may have to wait long to see a specialist and receive IV fluids.

Which insurance conditions apply?

Medicare has set certain conditions that must be met for patients to be eligible for Leqembi insurance.

Leqembi coverage requirements

• You must be enrolled in Medicare.
• You must be diagnosed with mild cognitive impairment or mild Alzheimer’s disease with signs of amyloid plaque in the brain.
• You’ll need a doctor to participate in a registry that collects information about the tests you’ve had as part of your diagnosis, to determine if you’re taking blood thinners, and to document if you’ve had any side effects with Leqembi.

To be diagnosed with Alzheimer’s or mild cognitive impairment, patients must undergo cognitive testing and undergo a PET scan or spinal biopsy to detect the amyloid protein associated with the disease. PET scans are the most common method of detecting amyloid because they are less invasive.

Medicare currently covers a single PET scan per life to detect amyloid. CMS is reconsidering this policy and plans to issue a proposed rule soon, an agency spokesman said.

The requirement that doctors must enter information about the patient in a register system is controversial. The Alzheimer’s Association and some members of Congress fear that mandatory data collection will add unnecessary bureaucracy to treating patients.

The Federal Centers for Medicare and Medicaid Services have created a statewide portal to make it easier for physicians to enter the necessary information about their patients. CMS has released a video showing doctors how to navigate the system:

Physicians can access the free register on this website.

dr David Knopman, an Alzheimer’s neurologist at the Mayo Clinic in Minnesota, said the registry is minimalist and likely won’t be a burden on patients and doctors.

What are the benefits and risks?

Patients who have been diagnosed with mild cognitive impairment or mild Alzheimer’s disease need to talk to their doctor about whether Leqembi’s benefits outweigh its risks, according to CMS.

Although Leqembi slightly slowed cognitive decline in the clinical trial, the treatment also carries serious risks of brain swelling and bleeding. In the study, 13% of the patients receiving Leqembi experienced swelling and 14% bleeding.

The swelling and bleeding were usually mild with no obvious symptoms, but these episodes can be fatal, based on the Food and Drug Administration’s independent review of clinical trial data. When symptoms do occur, they include headache, confusion, dizziness, blurred vision, and nausea.

People with two copies of a gene mutation called APOE4 are at higher risk of swelling and bleeding, and patients should be tested before taking Leqembi to confirm if they have the mutation, the FDA said. Medicare covers testing for the APOE4 mutation, a CMS spokesman said.

And patients taking anticoagulants also appear to be at higher risk of cerebral hemorrhage, according to the FDA.

Three patients who received Leqembi in the study died, although the FDA could not determine whether these deaths were related to the treatment.

Knopman said appropriately diagnosed and informed patients should be able to make their own decision about taking Leqembi after weighing the benefits of the treatment against the risks of potential serious side effects.

For corporate executives in America, sleep is often that rare luxury they don’t have or can’t buy.

Success, especially early success, rarely comes without a few nights, but there’s a realization among the most well-known market leaders that burning the night oil isn’t a smart long-term strategy for productivity.

“I’ve tried to sleep less, but even though I’m awake longer, I’m able to do it less. And the brain pain is bad if I sleep less than six hours a night,” Elon Musk said in a recent interview with CNBC’s David Faber.

“I knew I wasn’t as perceptive when I was primarily into caffeine and adrenaline, but I was obsessed with work,” Bill Gates said in a blog post back in 2019.

Nike CEO John Donahoe leads a hectic life, dealing with a variety of issues that are both predictable, such as managing margins for a Wall Street that quickly turns sour at signs of financial distress, and the geopolitics of a massive US corporate presence in China and the social, cultural and political issues that have made corporations the target of both right and left factions.

This is a list of problems that can lead to trouble sleeping.

Well aware of this health risk, Donahoe told attendees at the recent CNBC CEO Council Summit in Santa Barbara, California, that he conducted a self-experiment to manage his sleep to fit his life and work needs. Donahoe can’t get seven hours of sleep every night, but he said he tries to get in for 70 hours of sleep every 10 days. Achieving that goal and not knowing exactly how much sleep he’s getting per night is a sleep science workaround that the Nike CEO says has worked for him.

However, this will not necessarily work for you. Several sleep experts polled by CNBC find Donahoe’s approach inadequate. Sleep science research has consistently shown that the average adult should aim for seven hours of sleep each night. However, scientists emphasize that the ideal length of sleep varies from person to person. Some people need more, some less. And given the demands of some professions, seven hours may not be feasible.

According to sleep scientists, the key is giving your body time to rest, which is crucial to increasing attention span and improving overall health.

Don’t rely on other people’s sleep tricks. study yourself

According to sleep experts, it’s not always the recommended seven hours of sleep that makes for a good night’s sleep. They say the most important place to start is to sleep according to your circadian rhythm, maintain a consistent bedtime, and avoid stimulants like caffeine after lunch.

Everyone has a circadian rhythm, which is defined as “an internal clock that synchronizes all physiological functions in the body.”

These rhythms affect how we sleep, and it’s important to keep these clocks in sync.

To help us pinpoint these patterns for ourselves, there are apps like Circadian, which plot your daily activities in an easy-to-understand chart to keep you in tune with your circadian rhythms. Smartwatches have also been shown to study circadian rhythms based on experience and provide clues on how to adjust if needed. Most everyday consumer technology that we carry or wear now offers some form of sleep tracking, whether it’s from a third-party app or from the device manufacturer. The Apple Watch has a Sleep app, as does Samsung’s Galaxy phone, Google Fitbit, and the Oura ring.

Sleep is an important pillar of health

dr Mark Wu, a professor of neurology and sleep medicine at Johns Hopkins University, says insufficient sleep at night is a major problem in today’s society.

“We consider sleep to be one of the most important pillars of health,” Wu said. “There are many things that can go wrong if you don’t get enough sleep. There are acute and chronic problems. In the acute phase, you’re basically sleepy the next day. Then attention is reduced, and attention is the basis for all your mental processes. Not getting enough sleep can have long-term health consequences.

Science suggests that prolonged waking up, like Musk and Gates once did, equates to alcohol poisoning. According to the National Institute for Occupational Safety and Health (NIOSH), being awake for 24 hours is equivalent to a blood alcohol content of 0.10%. The legal limit for driving in the United States is 0.08%.

sleep, cardiovascular system

The National Heart, Lung, and Blood Institute says that not only does not getting enough sleep each night affect how we think, but it can also affect our cardiovascular, metabolic, respiratory, and immune systems.

When our circadian patterns are out of sync, the risk of disease increases.

Lack of sleep has been shown to promote glucose intolerance, which can lead to diabetes even in apparently perfectly healthy individuals. Obesity is another risk, as insufficient sleep can impair the part of the brain that controls our hunger. Blood pressure is also a concern. The less sleep we get, the higher our blood pressure rises, putting us at risk for heart disease and stroke. The worst forms of sleep deprivation have serious health effects. For example, insomnia is associated with a higher risk of developing depression.

A nine-year study conducted at Ball State University found that sleep deprivation has increased across all labor force groups in the United States in recent years, although the risk is higher in some occupations. The rate of short sleep duration has been found to be particularly high among individuals working in security and military, healthcare, manufacturing, and transportation.

dr Jagdish Khubchandani, a professor of public health at New Mexico State University and a contributor to the Ball State study, says managing sleep is part of work-life balance that we need to be leaders in maintaining. In that sense, Nike’s CEO is taking the right approach.

“You are the No. 1 player,” said Khubchandani. “In the American workplace, we need to start thinking. There is no one here monitoring my sleep and I have to take care of myself.”