The introduction of lecanemab, a new infusion therapy for Alzheimer's disease (AD), has unveiled stark disparities in access and adoption among Medicare beneficiaries across the United States. Recent research published in JAMA Network Open reveals that the uptake of this novel drug disproportionately favors patients who are male, White, urban-dwelling, and of higher socioeconomic status, casting a harsh light on enduring inequities in healthcare delivery for neurodegenerative diseases. This analysis raises critical questions about the intersection of cost, healthcare infrastructure, and social determinants in the accessibility of cutting-edge therapies.
Lecanemab stands as one of the first disease-modifying therapies to gain broad Medicare coverage, a landmark decision made in July 2023. Unlike symptomatic treatments that only temporarily alleviate cognitive symptoms, lecanemab aims to alter the pathological progression of AD by targeting amyloid-beta plaques, a hallmark of the disease. Despite the scientific promise this represents, clinicians and policymakers remain divided over its clinical effectiveness and safety profile, as well as the financial burden imposed by its considerable price tag of $26,000 annually, compounded by an estimated $7,000 in additional healthcare costs for diagnostic tests and infusion sessions.
The study, spearheaded by medical student Frank Zhou from UCLA's David Geffen School of Medicine, conducted a comprehensive analysis of Medicare fee-for-service data spanning from July 1, 2023, through March 31, 2024. The researchers juxtaposed the demographic characteristics of lecanemab recipients against the broader Medicare population diagnosed with either Alzheimer's disease or mild cognitive impairment (MCI), the latter being a precursor or early stage in the AD continuum. This comparative approach allowed the investigators to calculate uptake rates across various subpopulations and highlight significant disparities.
Demographically, the data indicates a pronounced skew: out of 1,725 Medicare beneficiaries who initiated lecanemab therapy, nearly 91% were White, almost 49% were male, and 88% resided in urban areas. Strikingly, 98.7% were classified as having higher socioeconomic status based on proxies such as ineligibility for low-income federal subsidies. These figures sharply contrast with the complete pool of 842,192 diagnosed patients, where Whites accounted for 82%, males constituted 36.4%, and about 82% were urban residents, with only 75% in the higher socioeconomic bracket.
When examining uptake rates quantitatively, the disparities become even more stark. White patients received lecanemab at a rate of 0.23%, compared to a mere 0.04% for Black patients and 0.09% for Asian/Pacific Islander patients. Socioeconomic stratification was even more striking: those with higher incomes accessed the drug at rates nearly 24 times greater than those from lower socioeconomic groups (0.27% vs. 0.01%). Urban patients were also prioritized disproportionately over rural ones, receiving the drug at a 0.22% versus 0.14% uptake rate, respectively.
According to Dr. John N. Mafi, associate professor at UCLA and study co-senior author, such patterns underscore a persistent matrix of inequalities entrenched in the US healthcare system. "While the drug's clinical and logistical demands -- including not just the steep annual cost but the requisite serial imaging and monitoring procedures -- contribute to access challenges, these disparities also mirror longstanding systemic barriers that have historically marginalized minority and socioeconomically disadvantaged groups from novel therapeutic advancements," Dr. Mafi explained.
One limitation of this analysis lies in its reliance on Medicare fee-for-service data, excluding Medicare Advantage recipients who comprise a substantial portion of the elderly population and may experience different patterns of drug utilization. Moreover, the identification of AD and MCI cases was based solely on diagnosis coding, which risks underestimation or misclassification and does not differentiate disease severity or adherence to specific treatment eligibility criteria. These methodological constraints suggest that actual disparities may be even more pronounced.
The broader clinical community remains circumspect regarding lecanemab's place in AD management, given its modest efficacy in slowing cognitive decline and associated risks, including cerebral hemorrhages. Frank Zhou emphasized the need for nuanced patient-physician dialogue when considering initiation of this therapy, especially in the context of relatively marginal clinical gains versus high economic and safety costs. He additionally urged Medicare to leverage real-world evidence from registries tracking lecanemab users to continually reassess coverage policies, optimizing resource allocation within constrained federal budgets.
Interestingly, this study's findings reinforce a crucial dialogue about the prioritization of healthcare expenditures. As Alzheimer's disease relentlessly increases in prevalence amid an aging population, stakeholders must balance investment in high-cost pharmacotherapy with bolstering supportive and caregiving infrastructures that arguably offer more immediate and widespread benefits to patients and families. The disproportionate benefits accruing to socioeconomically advantaged patients from lecanemab threaten to widen existing health disparities unless deliberate policy interventions are enacted.
This investigation adds to the expanding literature documenting inequities in access to novel medical therapies within the United States, particularly for vulnerable populations affected by neurologic disease. As second-generation and potentially more efficacious AD therapies approach clinical availability, the ethical imperative to ensure equitable distribution gains urgency. Facilitating broader access calls for addressing not just the financial obstacles but also systemic barriers -- such as geographic healthcare deserts, provider biases, and complex care coordination requirements -- that disproportionately hinder marginalized groups.
Future research should incorporate patient-reported outcomes and qualitative data to understand the multifactorial drivers behind lecanemab uptake. Moreover, integrating data across Medicare Advantage and commercial insurance beneficiaries will furnish a more comprehensive depiction of utilization trends. Policymakers could consider crafting subsidy programs or revising eligibility criteria to expand access while maintaining vigilance for safety monitoring. Ultimately, achieving equitable deployment of transformative therapies for Alzheimer's disease demands concerted collaboration across medical, economic, and social domains.
As the field of neurology enters a new era marked by the cautious optimism around disease-modifying agents like lecanemab, the lessons from this early uptake study must inform health systems design and reimbursement frameworks. Only through targeted policy action can the hope embodied by scientific innovation translate into tangible improvements for all patients burdened by dementia, regardless of race, gender, geography, or economic status.
Subject of Research: People
Article Title: Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries
News Publication Date: 15-May-2025
Web References:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2025.11711
References:
JAMA Network Open, "Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries," 15 May 2025.
Keywords: Alzheimer disease, socioeconomics, social inequality, health disparity, health equity