Why Aduhelm will likely cost many patients $5K+ more than its list price

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Biogen's Alzheimer's drug Aduhelm has made headlines during the past month for its controversial FDA approval and annual price list price of $56,000. But Medicare and other insurers will likely wind up paying between $61,000 and $62,000 for the drug, according to an analysis published July 9 in Health Affairs.

Peter Bach, MD, the director of New York City-based Memorial Sloan Kettering Cancer Center's drug pricing lab, analyzed how much the drug will cost after accounting for how the drug is packaged and administered.

Aduhelm and other infused drugs are administered based on a patient's weight, meaning heavier patients need higher doses than lighter patients. Patients who are prescribed Aduhelm receive 10 milligrams for every kilogram of body weight.

Biogen based Aduhelm’s $56,000 annual list price on the three vials required to treat a patient who weighs 163 pounds, according to The Wall Street Journal. Biogen said 163 pounds is the average weight of Alzheimer's patients in the U.S. who have the symptoms Aduhelm is meant to treat.

For patients weighing 200 pounds, the annual price rises to $68,430. A 170-pound patient's annual price would be about $59,000, and a 150-pound patient's annual price would be about $49,500.

Hospitals may discard any excess drug left over in Aduhelm's vial, though the insurer would have to pay for the whole vial. If 500,000 patients receive full doses of Aduhelm for a year, the amount of excess discarded drug would result in an additional $2 billion in annual revenue for Biogen, according to Dr. Bach's analysis.

A Biogen spokesperson told The Wall Street Journal Dr. Bach overestimated the amount of excess drug the hospital will discard. "Biogen works with physicians to ensure efficient use of vials to minimize wastage," the spokesperson said.

Aduhelm, which was approved June 7 using the FDA's accelerated approval pathway, was the first Alzheimer's treatment approved by the FDA since 2003.

The approval sparked an intense debate in the pharmaceutical and medical communities, with critics saying there was not enough evidence of clinical benefits to warrant an approval. Three members of the FDA's advisory committee resigned over the approval, and two House committees are investigating the drug's pricing and approval.

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