How Much Does Leqembi Cost? What Patients Actually Pay

Leqembi (lecanemab) carries a list price of about $26,500 per year, but the drug’s sticker price is only the starting point of what treatment actually costs. Between infusion fees, brain imaging for safety monitoring, genetic testing, and coinsurance obligations, the real annual bill for a patient and their family can land well above or well below that headline number depending on insurance status, care setting, and which formulation is used. Understanding the full financial picture matters because this is not a short-term prescription: treatment continues indefinitely as long as the patient benefits.

The $26,500 List Price

Eisai, the manufacturer, set Leqembi’s annual wholesale acquisition cost at $26,500 per patient per year when it launched in the United States.¹ That figure covers the drug itself, dosed by weight and administered by intravenous infusion every two weeks. It does not include any of the ancillary services a patient needs while on therapy: the infusion appointments, the MRI scans to check for brain swelling or microbleeds, the diagnostic workup to confirm eligibility, or the genetic testing that helps gauge risk.

The list price is what gets billed to an insurer or federal program. No patient without insurance is expected to pay it out of pocket in a single lump sum, though patients without adequate coverage could face enormous exposure. Eisai offers a patient assistance program for uninsured and underinsured individuals, but the specifics depend on income and other criteria that change over time. For the vast majority of Leqembi patients, the practical question is what share of the total cost their insurance leaves them responsible for.

What Medicare Beneficiaries Pay

Most people diagnosed with early-stage Alzheimer’s disease in the U.S. are 65 or older, which means Medicare is the dominant payer. After CMS granted traditional coverage for Leqembi, the drug moved under Medicare Part B, which covers physician-administered medications. Under Part B’s standard cost-sharing structure, a beneficiary owes 20 percent of the Medicare-approved amount after meeting the annual deductible. Twenty percent of $26,500 is roughly $5,300 a year just for the drug, before any infusion or monitoring fees.

That $5,300 estimate, however, is a ceiling for many patients rather than what they actually hand over. Beneficiaries with Medigap (Medicare Supplement) plans often have their 20 percent coinsurance covered entirely or nearly so. Those enrolled in Medicare Advantage plans face a different cost-sharing structure that varies by plan; some Medicare Advantage insurers have imposed prior authorization requirements or narrower eligibility criteria. Patients dually eligible for Medicaid typically pay little to nothing out of pocket, because Medicaid picks up Part B cost-sharing.

For someone on traditional Medicare with no supplemental coverage and no qualifying assistance program, the out-of-pocket drug cost alone could run around $440 a month. Add infusion and monitoring fees, and the annual personal obligation can climb substantially higher. This is a meaningful financial burden for retirees on fixed incomes, and it is one reason financial counseling has become a standard part of the treatment-initiation process at many memory clinics.

The Hidden Costs Beyond the Drug

The drug price captures only part of the total treatment expense. A budget-impact analysis modeling Leqembi costs in Ireland estimated total first-year per-patient costs at roughly €36,800 (approximately $40,000 at recent exchange rates), which included about €22,000 for the drug itself, €2,000 for the diagnostic workup, and €12,800 for monitoring and administration. In subsequent years, costs dropped to about €31,150 per patient as the intensive early monitoring phase wound down.² While the Irish health system is structured differently from U.S. Medicare, the breakdown illustrates a universal pattern: administration and monitoring represent a large chunk of overall spending, especially in the first year.

An analysis of the chronic biweekly infusion regimen estimated direct medical costs at about $45,200 per patient, driven by around 188 clinic visits. Infusion delivery alone accounted for roughly two-thirds of that cost, with clinical evaluations making up about 28 percent and MRI monitoring about 6 percent.³ These are costs the health system absorbs, but they trickle down to patients through coinsurance, copays, and the sheer time burden of biweekly hospital visits.

The specific add-on costs include:

MRI monitoring: Leqembi’s label calls for periodic brain MRIs to detect ARIA (amyloid-related imaging abnormalities), a side effect involving brain swelling or small bleeds. Patients typically need multiple MRIs in the first year and continued scans thereafter. Each MRI can cost several hundred dollars at Medicare rates, and patients owe their coinsurance share.
Infusion center fees: Each biweekly infusion visit carries facility fees and nursing time charges. In some countries the reimbursement for infusion services is so low that hospitals lose money per visit. In Japan, for instance, the combined infusion procedure fee and consultation fee for a single outpatient Leqembi visit barely reached the equivalent of $10, not counting the drug itself, meaning hospitals there have struggled to break even on delivering the treatment.⁴
Diagnostic workup: Before starting Leqembi, patients need confirmation of amyloid pathology, usually through a PET scan or cerebrospinal fluid analysis. Amyloid PET scans can cost $3,000 to $5,000 or more. Medicare covers amyloid PET in certain circumstances, but coverage varies by setting and indication.

Genetic Testing and Who Pays for It

ApoE genetic testing has become part of the clinical conversation around Leqembi because carrying two copies of the ApoE ε4 gene variant is associated with a higher risk of ARIA side effects. Knowing a patient’s ApoE status helps clinicians weigh the risk-benefit balance and informs monitoring intensity. The test itself is relatively inexpensive, around $125 as a one-time cost.⁵

The catch is that many private insurers have historically refused to cover ApoE genetic testing. A review of private payer coverage policies found that five out of seven insurers with relevant policies explicitly excluded ApoE testing, often citing a rationale that the results would not change clinical management or framing the test as investigational.⁶ That rationale was written before Leqembi existed, and the landscape may be shifting now that ApoE status has direct treatment implications. Still, patients should be prepared for the possibility that this test comes out of pocket, and at $125 it is a modest expense relative to the rest of the treatment bill. Some patients opt to obtain the test through direct-to-consumer genetic testing services outside the hospital system.

The Subcutaneous Version and What It Could Save

Eisai has developed a subcutaneous (under-the-skin) injection formulation of Leqembi, which received FDA approval and could fundamentally change the cost equation for patients who currently rely on biweekly IV infusions. The potential savings are substantial. A U.S. cost-comparison model estimated that switching from IV to subcutaneous Leqembi could save roughly $72,900 to $80,900 per patient over four years, translating to annual savings of about $18,200 to $20,200.⁷

Those savings come from three places: a roughly $40,600 reduction in treatment costs over four years, about $8,150 saved in administration time, and $24,100 to $32,100 in quality-of-life-related cost reductions. The subcutaneous formulation eliminates the need for an infusion center visit every two weeks, which is a significant logistical and financial relief. Instead of spending an hour or more in a chair at an infusion clinic, patients or caregivers can administer the injection at home or in a doctor’s office in minutes.

Modeling of different administration scenarios found that a fully subcutaneous regimen (subcutaneous from the start through maintenance) resulted in the lowest total treatment hours and the least caregiver productivity loss compared to IV-only or mixed regimens.⁸ For families already stretched thin by the demands of caregiving, cutting infusion visits by half or more translates directly into hours of recovered time and reduced travel costs. At a population level, broad adoption of the subcutaneous formulation was projected to save billions of dollars over four years.⁷

The Cost-Effectiveness Debate

Whether Leqembi is worth its price is one of the most contested questions in Alzheimer’s care. Multiple health-economic analyses have concluded that at the current list price, the drug does not meet conventional cost-effectiveness thresholds. One widely cited lifetime cost-effectiveness model found that Leqembi was not cost-effective at a willingness-to-pay threshold of $150,000 per quality-adjusted life year.¹ That is a standard benchmark used by economists to judge whether a treatment delivers enough health benefit to justify its price tag.

A separate analysis went further, estimating that Leqembi would need to be priced below $5,100 per year to be considered cost-effective when using the most favorable testing and treatment strategy (cerebrospinal fluid testing followed by targeted treatment).⁹ That represents an 80 percent discount from the current list price. Standard of care alone (supportive treatment without Leqembi) was the optimal strategy from a pure cost-effectiveness perspective in that analysis.

These findings do not mean the drug has no clinical value. The clinical trial showed a statistically significant slowing of cognitive decline compared to placebo over 18 months. The cost-effectiveness analyses are measuring whether the amount of slowing justifies the total expense, including all the ancillary costs discussed above. For a family watching a loved one decline, even modest slowing of symptoms may feel priceless. But from a system-wide budgeting standpoint, the math is hard to make work at current prices, and this tension underlies much of the policy debate around coverage and access.

How Prices Compare Internationally

The $26,500 U.S. list price is high by global standards, though not all countries have approved or launched the drug at the same price point. A threshold analysis across 174 countries estimated what Leqembi’s “value-based price” would need to be in different economic settings to be considered cost-effective. For high-income countries, value-based prices ranged from about $254 to $9,434 per year. For upper-middle-income countries the range dropped to $90 to $1,025, and for low-income countries the economically justifiable price was as low as $4 to $18 per year.¹⁰

Even at the top of the high-income range, the value-based price ceiling of about $9,400 is far below the U.S. list price. This gap helps explain why adoption has been slower than expected in many countries. Japan, which approved Leqembi relatively early, has faced infrastructure and reimbursement challenges that have limited real-world uptake despite the drug being available. The financial strain on hospitals delivering the infusions, combined with the modest reimbursement for administration services, has created bottlenecks even in a system where the patient’s share of drug costs is capped by national insurance.⁴

In practice, most countries outside the U.S. either negotiate lower prices, impose health-technology-assessment gates before agreeing to cover the drug, or have not yet approved it. Patients in those countries may face long waits for access or may need to pay privately, which is prohibitive for all but the wealthiest families.

The Caregiver Cost That Does Not Show Up on a Bill

When people ask what Leqembi costs, the discussion usually centers on the drug, the infusions, and the medical monitoring. But Alzheimer’s disease imposes staggering indirect costs that rarely appear on any invoice. One economic analysis estimated the total indirect costs of Alzheimer’s disease in the United States at $832 billion, with roughly 72 percent of that ($599 billion) attributable to the burden on unpaid caregivers and 28 percent ($233 billion) to patient productivity losses.¹¹ Those numbers dwarf the direct medical spending on the disease.

Leqembi’s biweekly infusion schedule adds its own caregiver burden. Someone needs to drive the patient to the infusion center, wait during the appointment, and drive home. Over the course of a year, that amounts to dozens of half-days consumed by treatment logistics. The chronic biweekly infusion model estimated that switching from every-two-week to every-four-week infusions roughly cuts caregiver burden in half.³ The subcutaneous formulation, which can be given at home, promises an even larger reduction. For families already stretching themselves thin, these time savings translate into real money: less time off work, fewer transportation costs, and less emotional exhaustion.

This is the lens through which many families evaluate Leqembi’s price. If the drug slows the progression from mild cognitive impairment to moderate dementia by even several months, the avoided costs of full-time caregiving or memory-care placement can be enormous. A year of memory-care facility costs in the U.S. routinely exceeds $60,000 and can top $100,000 in high-cost regions. Whether Leqembi delays that transition enough to offset its own price tag is an open and deeply personal question, but the potential savings on the caregiving side are part of the full financial calculus that families and policymakers are wrestling with.

Practical Steps to Manage What You Pay

If you or a family member is considering Leqembi, a few concrete steps can help minimize out-of-pocket exposure. First, review your Medicare supplement or Medicare Advantage plan’s cost-sharing structure before starting treatment. The difference between a Medigap plan that covers Part B coinsurance and one that does not can mean thousands of dollars a year. Second, ask your prescribing clinic about Eisai’s patient support program, which may cover copays or coinsurance for eligible patients. Third, factor in the full treatment cost, not just the drug: budget for MRI copays, infusion facility fees, and the ApoE genetic test if your insurer does not cover it.

Ask your neurologist whether the subcutaneous formulation is an option for you, because it can dramatically reduce both your direct costs and the time burden on your family. If you are on traditional Medicare with limited supplemental coverage, consider whether a Medicare Advantage plan with an out-of-pocket maximum might offer better protection for a treatment this expensive. And finally, keep in mind that eligibility for Leqembi is restricted to early-stage Alzheimer’s disease with confirmed amyloid pathology. The diagnostic workup to establish eligibility is itself a significant expense, so understanding your insurance coverage for amyloid PET scans or lumbar puncture before you start the process can prevent unwelcome surprises.