The Pricing of Alzheimer’s Medication: Is it fair?

There is another side to the FDA’s decision on Monday to approve a new Alzheimer’s medication. The cost.

More than six million Americans with Alzheimer’s will be eligible to take the drug, which will be sold under the brand name Aduhelm and must be given as a monthly intravenous infusion. Biogen said it would charge an average of $56,000 a year per patient.

That price tag is higher than many Wall Street analysts had expected. The company’s shares soared 38 percent on Monday. The Institute for Clinical and Economic Review, which evaluates the value of medicines, has estimated that Biogen’s drug would be cost-effective only below $8,300.

While only patients with mild cognitive decline were enrolled in the clinical trials, the F.D.A. approved the drug for anyone with Alzheimer’s, a much broader group of patients than many experts were expecting.

Dr. Steve Miller, the chief clinical officer at the insurer Cigna, said on Monday that he expected his company and most of its peers would pay for the drug only for patients with mild cognitive symptoms and higher-than-normal levels of the protein amyloid in their brains.

“There’s just no data that more advanced patients will benefit,” he said.

Dr. Miller said he was disappointed that the F.D.A. had made so many patients eligible. “You’re leaving the tough decision-making about who should be covered to the individual payers,” he said.

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Read more here: Courtesy of the NY Times