What are the out-of-pocket costs patients face for 2025 FDA-approved Alzheimer’s drugs?
Executive summary
Patients prescribed 2025 FDA‑approved Alzheimer’s drugs face variable but often substantial out‑of‑pocket exposure that depends on the drug’s list price, Medicare cost‑sharing rules, required diagnostic and monitoring services, and whether patients have supplemental coverage; Leqembi’s list price is $26,500 a year and Kisunla’s first‑year list price was announced at about $32,000, while earlier Aduhelm carried an initial $56,000 tag [1] [2] [3] [4]. Under standard Medicare Part B rules beneficiaries typically pay 20% coinsurance after any deductible — translating into several thousand dollars per year just for the drug itself — and total patient bills rise when PET scans, MRIs, genetic testing and specialist visits required by these therapies are included [1] [5] [6].
1. List prices set the headline, but they’re only the starting point
Manufacturers have set annual list prices that anchor patient exposure: Eisai/Biogen priced Leqembi at $26,500 per year and Lilly set Kisunla at roughly $32,000 for the first year; Biogen’s earlier Aduhelm launched at $56,000 a year, illustrating how headline prices vary across products and launches [1] [2] [3] [4]. Those figures matter because Medicare Part B covers infused and physician‑administered biologics under a payment model that leaves beneficiaries with roughly 20% coinsurance — a simple math that converts list price into thousands in potential patient responsibility unless other coverage steps in [1].
2. Medicare cost‑sharing and real patient bills: several thousand to double‑digit thousands
Applying the standard 20% coinsurance to list prices produces immediate estimates: for Leqembi that’s roughly $5,300 annually in drug coinsurance alone and for Kisunla roughly $6,400 in a first year, assuming beneficiaries have hit any Part B deductible and have no supplemental coverage [1] [3]. Analysts and studies project higher patient burdens once monitoring is added — estimates for lecanemab (Leqembi) out‑of‑pocket costs including testing and imaging range from about $6,600 per year for patients without supplemental coverage to modeled estimates near $11,000 annually under some Part D/Part B scenarios [5] [6].
3. Monitoring, diagnostics and safety checks can multiply out‑of‑pocket exposure
These amyloid‑targeting therapies require confirmatory amyloid testing (PET or cerebrospinal fluid), regular MRIs to screen for amyloid‑related imaging abnormalities, specialist visits and other safety monitoring — services that drive additional costs that Medicare or supplemental plans may or may not fully absorb; ICER modeling counted tens of thousands more in total system costs per patient once those services are included even while taxpayers, not patients, pick up much of that tab under Medicare [5]. CMS estimates and projections of program spending — such as a cited $3.5 billion potential Medicare spend for one drug in 2025 — make clear the broader fiscal footprint that shapes benefit rules and patient access [7].
4. Coverage rules, supplemental plans and manufacturer programs change the picture
Actual out‑of‑pocket exposure depends heavily on whether beneficiaries carry Medigap, Medicare Advantage, or state Medicaid wraparound coverage: some manufacturers and payers point to programs that eliminate, limit or cap patient exposure for most eligible Medicare enrollees, and Lilly has said more than 98% of eligible Medicare patients have coverage that reduces annual out‑of‑pocket exposure — a claim that shifts how many patients ultimately pay the headline coinsurance [8]. Equally important, some drugs (notably Kisunla) have trial data and labeling that allow clinicians to stop therapy if amyloid is cleared, which could reduce total patient spending compared with open‑ended chronic dosing [9] [3].
5. Competing narratives and the limits of current data
Advocacy and industry narratives emphasize access and patient assistance, while policy analysts warn that even modest coinsurance on expensive drugs can be catastrophic for retirees on fixed incomes — KFF used Aduhelm math to show coinsurance near $11,500 that could represent a large share of typical beneficiary income [4]. Available reporting provides concrete list prices, Medicare payment rules, and multiple modeled out‑of‑pocket estimates, but lacks comprehensive real‑world datasets showing what patients actually paid in 2025 across plans and programs; the evidence is therefore a mix of firm list‑price math, CMS spending projections, and model‑based estimates of monitoring costs [1] [7] [5] [6].
Conclusion
The straightforward bottom line is that 2025 FDA‑approved Alzheimer’s drugs can impose out‑of‑pocket costs ranging from a few thousand dollars a year (drug coinsurance under Part B) to well over $10,000 annually once monitoring and weaker insurance are factored in, but individual liability may be much lower for patients with robust supplemental coverage or manufacturer support and could be curtailed if therapies can be stopped after successful amyloid clearance [1] [5] [9] [8]. Current reporting provides clear price points and plausible modeled ranges, but lacks a full population‑level accounting of actual patient payments across insurance types in 2025.