Pennsylvania
Some Pennsylvania insurers won’t cover new Alzheimer’s treatment for some customers
Some private insurers are balking at paying for the first drug fully approved to slow mental decline in Alzheimer’s patients.
Insurers selling coverage in North Carolina, Pennsylvania and New York, among other states, told The Associated Press they won’t cover Leqembi with insurance offered on the individual market and through employers because they still see the $26,000-a-year drug as experimental.
Their decision stands in contrast to Medicare, which will wind up covering most patients who take the drug. The federal coverage program mainly for people ages 65 and older announced shortly after Leqembi received full approval last month that it will cover the treatment while still tracking its safety and effectiveness.
Leqembi is the first medicine that’s been convincingly shown to slow the cognitive decline caused by Alzheimer’s disease, though only modestly. The U.S. Food and Drug Administration approved the IV drug for patients with mild dementia and other symptoms caused by early Alzheimer’s.
That approval came after regulators reviewed data from a large study in which the drug slowed memory and thinking decline by about five months in those who got the treatment compared with those who got a dummy drug. Some Alzheimer’s experts say the delay is likely too subtle for patients or their families to notice.
Alzheimer’s mainly affects the elderly. About 76% of the people taking Leqembi will be covered by Medicare, according to the Japanese drugmaker Eisai, which developed the drug and is co-marketing it with Cambridge, Massachusetts-based Biogen Inc.
But people under 65 — even, rarely, as young as their 30s — also can get diagnosed. They are more likely to have commercial coverage.
“That’s why we’re just dumbfounded that commercial plans are not covering it,” said Christine Mann, chief operating officer of the Buffalo, N.Y.-area Dent Neurologic Institute, which will provide the IV drug to patients. “It’s almost like discrimination against these patients.”
The full picture on commercial insurance is still emerging in the patchwork U.S. system of coverage.
Companies saying no so far include Highmark, which provides Blue Cross and Blue Shield coverage in New York, Pennsylvania, Delaware and West Virginia; Blue Cross and Blue Shield of North Carolina, which has about 1.8 million commercial customers; and Philadelphia-based Independence Blue Cross.
Highmark and the North Carolina plan say they are still monitoring Leqembi and could re-evaluate their decision.
Independence Blue Cross made its decision after reviewing published, peer-reviewed studies and publicly available FDA materials.
“That re-evaluation made it clear to us that the existing evidence does not allow for conclusions to be drawn about the safety and effectiveness of Leqembi,” said Dr. Heidi Syropoulos, a medical director with the insurer.
A Highmark spokesman said that company made its decision after also consulting with specialists to determine if the drug’s benefit outweighs its side effects, which include brain bleeding and swelling.
Prominent insurers that will cover the drug for commercial plans include Kaiser Permanente and Elevance Health, the largest provider of Blue Cross-Blue Shield plans in the United States. A spokesman for another big health insurer, UnitedHealthcare, declined to comment when contacted by AP.
Because Medicare covers the drug, patients with privately run Medicare Advantage plans will receive coverage, said Juliette Cubanski, of the non-profit KFF, which researches health care issues.
Many other insurers say they have yet to make a decision.
Most insurers will probably cover the drug but heavily restrict its use through things like requiring pre-approval, said Greg Warren, a health actuary and member of the Society of Actuaries.
For commercial coverage, insurers often pay for treatments that have full FDA approval. But that is not guaranteed.
Tufts Medical Center in Boston maintain a database that includes more than 11,000 commercial insurance coverage decisions on specialty drugs. In 2% of the decisions, insurers did not cover the FDA-approved use, said researcher James Chambers.
Chambers said they have found that the decision to not cover a drug largely happens when the evidence supporting the drug is considered questionable.
The denials for Leqembi don’t surprise Jack Hoadley, a health policy researcher with Georgetown University’s Center on Health Insurance Reforms.
He noted Leqembi’s serious side effects and high cost. The price doesn’t include the cost for repeated brain scans patients need to check for side effects.
But Hoadley said insurers also may have a hard time explaining themselves.
“It’s going to be a harder-to-justify decision for them if they know that Medicare has made a decision to cover it,” he said.
Patients who don’t get coverage through a commercial plan may eventually receive it through Medicare or state- and federally funded Medicaid programs.
But waiting is risky. Those who advance out of early-stage Alzheimer’s may no longer qualify for Leqembi.
Bonnie Bortz has been caring for her 38-year-old daughter, Jaime, who has early-onset Alzheimer’s like her father did.
Bortz, who lives in the Buffalo suburb of Cheektowaga, is confident Jaime will get help paying for Leqembi because she will soon start on Medicare, which is available to some people under 65 with Alzheimer’s. Still, that hasn’t happened yet, and Bortz is anxious for treatment to begin.
She’s watched Jaime progress from repeatedly losing her phone and keys to struggling to help her 7-year-old daughter with homework.
“I don’t want to get to the next stages of all this,” Bonnie Bortz said. “I want more time.”
Check your tickets! Someone in Pennsylvania won big in Friday’s Mega Millions drawing.
While the jackpot is still rolling, someone in Pennsylvania matched all five winning numbers drawn Friday night— 2-20-51-56-67, but not the Mega Ball, 19, to win $1 million. The Megaplier was 2X.
Three other Pennsylvania Mega Millions players matched four of five numbers drawn, winning $10,000.
Click here for more information from the Pennsylvania Lottery and to check if your ticket won anything.
The Mega Millions jackpot is estimated to be worth $944 million for the next drawing on Christmas Eve.
The Mega Millions odds are 1 in 302.6 million. Winners can choose an annuity with annual payments over 29 years, but most almost always take the cash option.
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New Hope, Pennsylvania, a quaint town of 2,500 people, is becoming a new celebrity haven as it offers a “peaceful and private lifestyle” away from the hustle and bustle of New York City, according to experts.
Gigi Hadid, Bella Hadid and their mother, Yolanda Hadid, bought a property in the tiny town in 2017, according to Realtor.
The property, which is called Carousel Farm, was purchased for $3.7 million and consists of a 5,0000 square-foot stone house, a barn that can accommodate 16 horses, and an in-ground pool, according to the outlet.
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Bella Hadid, Gigi Hadid and Yolanda Hadid reportedly purchased a home in New Hope, Pa., in 2017. (Kevin Mazur/Getty Images for V Magazine / Getty Images)
Aerial view of Yolanda Hadid’s farm in Pennsylvania (MEGA / Mega)
The listing of the property describes the home as a “gentleman’s estate” where guests can “relax around the pool, go riding on the 32+ acres, or just play your own version of Gatsby.”
In April 2020, Bella and Gigi posed for Vogue’s March issue on their ranch: “Postcard from Home for Vogue,” Gigi captioned her post.
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The Hadids’ home is called the “Carousel Farm” and is a 5,000 square-foot stone house in New Hope, Pa. (Bryan Bedder/Getty Images for Lifetime / Getty Images)
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Gigi’s ex-boyfriend and father of her child, Zayn Malik, also owns a home in New Hope.
Earlier this year, Malik spoke to British Vogue about the benefits of owning a property in the Pennsylvania town and said it’s a “great place to reflect on your thoughts and think about things without the noise of the world.”
He also noted that his home in New Hope gave him the inspiration for his latest album, “Room Under the Stairs.”
Zayn Malik told British Vogue about the benefits of owning a home in Pennsylvania earlier this year. (Swan Gallet/WWD via Getty Images / Getty Images)
The current man in Gigi’s life, Bradley Cooper, also owns a home in New Hope, just down the street from Carousel Farm, according to the New York Post. The outlet reported that Cooper, who grew up just an hour away in Jenkintown, purchased the home for $6.5 million in December 2023.
Zayn Malik and Gigi Hadid were previously in a relationship and share a daughter. (Mike Coppola/Getty Images for People.com / Getty Images)
Cooper’s newly purchased home was built in 1704 and has undergone extensive renovations, per The Post. The home has seven bedrooms, six bathrooms and is 6,300 square feet.
Tabitha Heit, a licensed relator, told Fox Business, “As a real estate agent licensed in both Pennsylvania and New York, I’ve noticed a significant trend of New Yorkers relocating to Pennsylvania.
“There are several reasons for this shift: the slightly milder climate, more affordable living compared to states like New York and New Jersey, and the overall appeal of the area.”
Gigi Hadid and Bradley Cooper reportedly own homes on the same street in New Hope, Pa. (Getty Images / Getty Images)
Bradley Cooper and Gigi Hadid have been romantically linked since October 2023. (Aeon/GC Images / Getty Images)
Heit told Fox Business that since inventory has been “tight” for years, the recent increase in demand has been driving up home prices.
“I would imagine celebrities are drawn to this area as well as it likely offers them a more peaceful and private lifestyle. New Hope, with its artsy vibe, is a standout town, and its location – just across the river from New Jersey – makes it incredibly accessible,” Heit noted.
“I would imagine celebrities are drawn to this area as well as it likely offers them a more peaceful and private lifestyle.”
She added, “Doylestown is another hot spot in Bucks County, offering charm, culture and a vibrant community that continues to attract buyers.”
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Carle Robbins, a broker in Pennsylvania and New Jersey, told Fox Business that New Hope and Doylestown are where celebrities like to dine.
“But the celebs live in the surrounding townships: Solebury, Upper Makefield, Plumstead, Tinicum,” Robbins added.
Justin Bieber is among the celebrities seen in New Hope, Pa., in recent years. (Jason Merritt / Getty Images)
According to Realtor, the median home price in New Hope is $1.3 million. The outlet also noted that New Hope is in the middle of New York and Philadelphia, which makes it an attractive location for commuters.
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The outlet reported that stars like Leonardo DiCaprio, Justin Bieber and Tina Fey have all been seen in New Hope in recent years.
Christmas decorations bring holiday vibes to the Beaver Valley Mall
Christmas trees and holiday displays bring a splash of color to the halls of the Beaver Valley Mall.
The Christmas holiday weekend is now just days away, and you’ll need to know what will be open and closed in Pennsylvania so you can properly navigate the holidays.
Here’s your Christmas roundup.
Christmas Day 2024 is on Wednesday and considered a federal holiday, so most regular business will be impacted.
Major banks will be closed on Christmas
The major banks — Bank of America, Capital One, Citibank, PNC, Wells Fargo and Truist — consider Christmas to be a bank holiday, and will be closed.
Will federal courts be open on Christmas?
All federal and Pennsylvania state courts and non-essential services will be closed on December 25.
Mail, packages won’t be delivered on Christmas Day
FedEx will be closed on Christmas Day, and will not deliver any packages.
All United States Postal Service locations will be closed Christmas Day and New Year’s Day. Regular post office hours and mail delivery will resume on the Thursday following each holiday.
UPS will be closed on Christmas as well, and will not deliver any packages.
Damon C. Williams is a Philadelphia-based journalist reporting on trending topics across the Mid-Atlantic Region.
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