Preparing the health-care system to pay for new Alzheimer's drugs.

Biogen's announcement last fall that it will seek U.S. Food and Drug Administration approval for its Alzheimer's disease (AD) treatment, aducanumab, 7 months after the drug was declared a failure, buoyed patients and families, but put health payers and policymakers on alert. Whether aducanumab succeeds, other disease-modifying therapies for AD will follow, and the health-care system is unprepared for the reimbursement and access challenges. Novel AD therapies are much needed, but we cannot assume substantial cost offsets. With forethought and preparation, however, the health-care system can accommodate new AD drugs. First, we urge the use of cost-effectiveness of new Alzheimer's treatments as a starting point for setting value-based prices. Second, payments for new AD therapies should ideally incorporate a performance warranty, which helps apportion risk associated with initial therapy value estimates between drug manufacturers and payers. Third, we urge consideration of "subscription" payment agreements to address system affordability issues.