Two experts in Alzheimer’s disease care say insurance coverage for newly approved treatments targeting agitation has been slow and restrictive, but persistence and advocacy are starting to ease access.
Insurers initially treated new drugs like generics
Anton Porsteinsson, director of the Alzheimer’s Disease Care, Research and Education Program at the University of Rochester, described the payer setting as “initially challenging.” Insurers routinely imposed step edits and prior-authorization requirements—tactics typically used to steer patients toward cheaper, off-label generics—even though no generic alternatives exist for the two FDA-approved therapies.
Both drugs, brexpiprazole and dextromethorphan-quinidine, are branded and carry high list prices. Porsteinsson said payers often demanded patients try older, unapproved medications first, despite weaker evidence and known safety risks. He called the practice ethically questionable and medically risky, especially when approved options are available.
Over time, he said, direct communication with insurers has helped. Clinicians have argued that forcing patients to fail on unproven treatments before accessing approved drugs not only delays effective care but also increases the risk of adverse events in a vulnerable population.
Patient assistance programs fill gaps
Alireza Atri, director of the Banner Sun Health Research Institute, highlighted manufacturer patient assistance programs as a critical resource. Many Alzheimer’s patients live on fixed incomes, and the high cost of branded drugs can be prohibitive. These programs, he said, help bridge the gap while clinicians work to secure insurance coverage.
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Atri framed early intervention as a win for everyone: medically, ethically, and economically. Identifying agitation early, diagnosing it accurately, and managing it appropriately can reduce hospitalizations, caregiver burnout, and long-term care costs. “It’s not just about treating symptoms,” he said. “It’s about preserving quality of life for patients and their families.”
Porsteinsson echoed the sentiment, calling agitation one of the most distressing aspects of Alzheimer’s. It’s common, he said, and its impact on daily life is profound. But with the right tools—awareness, structured evaluation, and access to effective treatments—clinicians can make a lasting difference.
He closed with a call to action for providers, caregivers, and patients: agitation is treatable, and the new therapies offer a real opportunity to improve outcomes. The challenge now, he said, is ensuring those treatments reach the people who need them.
The conversation left little doubt that the field is still finding its footing. Insurance hurdles remain, but the experts agreed that the shift toward recognizing agitation as a distinct, treatable condition is a step in the right direction.
