Medicare’s miss on Alzheimer’s drug spending

May 11, 2026 - 17:47

Far fewer seniors than expected are taking costly Alzheimer's drugs, leaving Medicare spending well below earlier government forecasts. The new class of amyloid-targeting treatments, including Leqembi and Kisunla, were initially projected to cost the federal program billions of dollars annually. But actual uptake has been slow, with only a small fraction of eligible patients starting therapy.

Several factors explain the gap. The drugs require intravenous infusions and frequent MRI scans to monitor for brain swelling or bleeding, which limits access for many patients, especially those in rural areas. Doctors also remain cautious about the modest cognitive benefits versus the risks and the burden of regular clinic visits. Medicare's strict coverage criteria require patients to have confirmed amyloid plaques and mild cognitive impairment or early-stage dementia, which narrows the pool.

The lower spending has surprised analysts who once warned these drugs could strain the Medicare trust fund. Some experts now say the program may save money compared to earlier worst-case scenarios. However, patient advocacy groups argue that the slow adoption reflects real-world barriers, not a lack of need. They point to the need for better diagnostic tools and more convenient treatment options.

For now, Medicare's experience with Alzheimer's drugs serves as a reminder that blockbuster drug launches do not always translate into blockbuster usage, especially in older, frailer populations with complex care needs. The coming years will show whether new formulations or expanded coverage can change the trajectory.