Reducing Costs for Alzheimer Disease With Better Tolerated Therapies

EP: 1.Lower Costs, Better Outcomes: Managed Care Strategies for DM-BUP Adoption

EP: 2.From Data to Decisions: Enabling Early Adoption of Cost-Saving Depression Therapies

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EP: 3.Reducing Costs for Alzheimer Disease With Better Tolerated Therapies

EP: 4.Leveraging Digital Monitoring for Major Depressive Disorder

Zachary Contreras, Director of Pharmacy Benefits at Sharp Health Plan, provided insights on data presented at AMCP Nexus regarding the use of dextromethorphan-bupropion (DM-BUP) for managing agitation in Alzheimer disease.1 The study reported that DM-BUP was well tolerated, with no signs of sedation or cognitive decline and no patients discontinuing due to side effects. This safety profile highlights the therapy’s potential to address a key unmet need in dementia care.

Contreras emphasized the need for payers to evolve cost-effectiveness models to capture the broader benefits of safer, better-tolerated therapies. These models should consider avoided costs associated with institutionalization, emergency department visits, psychiatric interventions, and adverse drug events such as false delirium. The study showed a 3.6-fold lower relapse risk among patients taking DM-BUP, indicating that effective management of agitation could meaningfully reduce high-cost events. Additionally, improvements in overall patient quality of life and caregiver burden were identified as important metrics for economic evaluation.

Access to treatment was another key focus. Contreras highlighted strategies such as favorable formulary tier placement, streamlined or eliminated prior authorizations, and updated treatment algorithms within behavioral health teams to ensure patients receive timely care. He stressed a holistic approach that involves behavioral health managers, medical management teams, caregivers, and family members to support both medication use and overall patient care.

Contreras also discussed the potential for DM-BUP to delay or prevent nursing home placement and emergency behavioral interventions. Agitation is a leading driver of institutionalization in patients with Alzheimer disease, with long-term care costs reaching $100,000 annually. By reducing agitation and stabilizing behavior, DM-BUP may allow patients to remain at home longer, decrease ER visits and hospitalizations, and reduce reliance on multiple medications or dose adjustments.

Overall, Contreras concluded that DM-BUP represents a promising advancement in Alzheimer care, offering a safer, effective, and well-tolerated option that can improve patient outcomes, enhance care continuity, and generate measurable cost savings for health systems and payers.