Alzheimer’s medicine costs more than the drug price. Eisai, the company that developed Leqembi, estimated $26,500 per year for the drug. KFF Health News reported ICER estimates that, in addition to that price, treatment could cost taxpayers $82,500 per patient per year on average for genetic tests, frequent brain scans, safety monitoring and other care.
How much does Alzheimer’s medicine cost per year?
Eisai said Leqembi, also called lecanemab, would cost an estimated $26,500 per year, and a CNBC report on Leqembi pricing noted that the exact price would vary by patient. CNBC also reported that Eisai’s launch price came in higher than an estimate from ICER, a nonprofit that analyzes drug prices. For donanemab, ask the prescribing clinic for its current price.
| Figure | Who gives it | What it covers |
|---|---|---|
| $26,500 per year (estimated) | Eisai, as reported by CNBC on January 9, 2023 | Drug price |
| $26,500 annual price tag | KFF Health News, KFF Health News cost report, August 2, 2023 | Drug price |
| $8,500 to $20,600 per year | ICER draft report, as reported by CNBC on January 9, 2023 | Price range ICER found cost-effective |
| $82,500 per patient per year, on average | ICER estimate, as reported by KFF Health News, August 2, 2023 | Cost to taxpayers for genetic tests, frequent brain scans, safety monitoring and other care, in addition to the drug price |
Prices and bundles change. These figures are as of the dates of the reports, so check today’s price with Eisai or your prescribing clinic.
Which tests, visits, administration and travel belong in the total?
KFF Health News reported the $82,500 figure as covering genetic tests, frequent brain scans, safety monitoring and other care. Each of those is a line to price on your own. The amyloid and tau PET use criteria from the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging rate scans differently by scenario: for amyloid PET, seven clinical scenarios were rated appropriate, two uncertain and eight rarely appropriate. Your clinician decides which tests apply to you. For how a dementia evaluation is priced, read neuropsychological testing cost and purpose.
| Cost line | What is reported | What to ask for |
|---|---|---|
| Drug | Eisai estimates $26,500 per year | The annual cost on your plan, with your share |
| Genetic tests | Included in the ICER-based $82,500 average reported by KFF Health News | The price of each test and whether your plan pays for it |
| Brain scans | “Frequent brain scans” are included in the $82,500 figure | The price of each scan and how many your clinician expects |
| Safety monitoring | Included in the $82,500 figure | The schedule of checks and the price of each |
| Follow-up visits | NIA’s general advice for people with memory problems is to check memory every six to 12 months (NIA memory problems guidance). That is not a visit schedule for Alzheimer’s antibody treatment | The visit schedule from the prescribing clinic, with fees and co-pays |
| Giving the medicine at the clinic | The reports do not itemize administration costs | An itemized quote from the clinic, including whether administration is in your quote |
| Travel | Your own cost, added on top of the figures above | Mileage, parking and lodging for each visit and scan |
The $82,500 figure is an average estimate, not a bill for any one person, so replace each line with quotes from your own clinic and pharmacy.
How are coverage conditions checked?
CNBC reported on January 9, 2023 that Medicare had limited coverage to people taking part in studies approved by the federal government. As of the January 9, 2023 CNBC report, CMS said it planned broader coverage if the drug received full FDA approval. KFF Health News reported that the FDA gave the drug full approval on July 6, and that, citing Eisai, Medicare and Medicaid patients would make up 92% of the market for lecanemab. Tricia Neuman of KFF, quoted by CNBC, said that even with Medicare coverage, beneficiaries would still be responsible for 20% coinsurance.
Coverage rules may have changed since those reports, so check the current version directly:
- Ask the prescribing clinic for the written coverage requirements it must meet, such as the disease stage.
- Call your plan, whether Medicare, Medicaid or private, and ask whether the drug needs prior approval and what your share will be.
- Read CMS’s current coverage policy for drugs that target amyloid on cms.gov. This is information, not legal advice. The coverage details above come from reports dated January and August 2023, so check CMS’s current policy.
Who can start, and how is eligibility checked?
CNBC reported on January 9, 2023 that the FDA granted accelerated approval after the treatment appeared to modestly slow the progression of Alzheimer’s disease in trial participants with mild cognitive impairment. KFF Health News estimated that about 1 million Alzheimer’s patients in the U.S. could qualify. The NIA notes that mild cognitive impairment may be an early sign of Alzheimer’s disease, but not everyone with it will develop Alzheimer’s.
The Alzheimer’s Association and SNMMI PET criteria are intended for dementia specialists. Those criteria concern amyloid and tau PET scans, not eligibility for the drug itself. The next step this page suggests is a specialist eligibility assessment: ask your doctor for a referral to a dementia specialist, who can check eligibility and whether biomarker testing applies to you.
If you are not sure whether the change you see is Alzheimer’s or another cause of memory loss, read alzheimer disease vs dementia first.
What safety risks are reported?
Clinical trial data published in the New England Journal of Medicine, as CNBC reported it, found that cognitive decline was 27% slower over 18 months for people who received Leqembi. In the same trial, 14% of people who received the drug suffered serious adverse events, compared with 11% of those who did not receive it. CNBC also noted that drugs like Aduhelm and Leqembi can cause brain swelling and bleeding. These are averages from a trial, not a promise for any one person.
For the monitoring schedule, including how often brain scans are taken, read the current FDA prescribing information for the drug and ask the clinic for its written schedule.
Medicines you already take can affect memory too. The NIA lists antihistamines for allergy relief, sleep aids, antipsychotics, muscle relaxants, medicines for urinary incontinence, and medications for cramps in the stomach, intestines and bladder as drugs that can impair thinking in older adults (NIA cognitive health guidance). Bring a full list of everything you take to the first visit.
Can you prevent Alzheimer’s disease?
The NIA states that nothing has been proven yet to prevent Alzheimer’s. A 2017 review by the National Academies of Sciences, Engineering, and Medicine found “encouraging but inconclusive” evidence for blood pressure management in people with high blood pressure, increased physical activity and cognitive training (NIA prevention research).
Where do I get answers to care questions?
Questions about life expectancy at age 75, how fast decline moves, when a care home makes sense, how often to visit, and whether to tell someone about the diagnosis are care questions, and this page covers medicine cost and monitoring. For those, call the NIA ADEAR Center at 800-438-4380. It offers information for families and caregivers and makes referrals to local and national resources.
Before you commit to a cost estimate
- Get the annual cost in writing, with your share, not just the list price.
- Ask whether your plan needs prior approval before the drug starts.
- Ask for the monitoring schedule and the price of each scan and check.
- If donanemab is the drug proposed, get its current price from the clinic.
- Ask how many clinic trips the plan needs, so you can price travel.
By the Global MH Summit Research Team