Donanemab Cost in 2026: Alzheimer’s Drug Price, Medicare Coverage & Patient Assistance Options

• “Donanemab Cost 2026: How Much Will Alzheimer’s Treatment Really Cost?”

• “Donanemab Price & Insurance in 2026: Medicare, Out-of-Pocket & Assistance”

• “2026 Guide to Donanemab Cost, Coverage & Patient Assistance for Alzheimer’s”

• “Donanemab 2026 Cost & Coverage: What Alzheimer’s Patients Need to Know”

(These titles incorporate high-value keywords like “cost”, “2026”, “Medicare”, “coverage”.)

Introduction

Donanemab (brand name Kisunla by Eli Lilly) is one of the newest monoclonal antibody therapies approved to slow disease progression in early Alzheimer’s disease. With its approval, many patients, caregivers, and health systems are asking: How much will it cost in 2026? Will Medicare cover it? And what patient assistance programs exist to help with the financial burden?

In this article, we provide the latest information (as of mid-2025), projected pricing, Medicare coverage rules, comparisons vs competing Alzheimer’s drugs, and 20 frequently asked questions (FAQ) to help patients and caregivers navigate the complexities.

Donanemab: Key Facts & Approval Status

• Donanemab was granted U.S. FDA approval in July 2024 under the brand name Kisunla for use in early symptomatic Alzheimer’s disease. Medscape+3Reuters+3Alzheimer’s Association+3

• The drug is designed to clear amyloid plaques, and dosing can potentially be stopped once amyloid levels reach minimal levels, which may reduce duration of treatment. Alzheimer's Research UK+3UCI MIND+3BioPharma Dive+3

• Its U.S. list price is set at approximately $32,000 per year (13 monthly infusions) for an average-weight patient. Medscape+4Easton Alzheimer’s Research Center+4UCI MIND+4

• The cost per vial is ~ $695.65. Medscape+4Lilly Investor Relations+4Medscape+4

• The manufacturer also offers limited-duration pricing: $12,522 for 6 months, $32,000 for 12 months, $48,696 for 18 months (if treatment continues to 18 months) depending on when amyloid clearance occurs. SCbio+5Lilly Investor Relations+5BioPharma Dive+5

• Economic modeling suggests that the economically justifiable price (EJP) of donanemab under certain cost-effectiveness thresholds ranges between $44,691 and $80,538 for a 1-year (13-dose) treatment, depending on efficacy and perspective (healthcare system vs societal) PMC+1

Projected Donanemab Costs in 2026

While the 2024 list price is $32,000/year, prices may evolve by 2026 (e.g. inflation, competition, payer negotiation). Below is a projected cost table:

* Projection is speculative, based on general pharma inflation and market pressures.
† Note: The prescribing labeling currently anticipates finite treatment durations rather than chronic indefinite dosing. Lilly Investor Relations+3SCbio+3BioPharma Dive+3

Additional cost considerations (not included above):

• Screening & biomarker tests (amyloid PET scans, genetic testing)

• MRI monitoring for safety (to detect ARIA: swelling or microhemorrhages)

• Infusion administration costs (clinic time, nursing, overhead)

• Follow-up visits and diagnostic assessments

These add-ons may add thousands of dollars annually beyond the drug cost itself.

Donanemab vs Competing Alzheimer’s Drugs (e.g. Leqembi)

Here’s a side-by-side comparison of donanemab vs lecanemab (Leqembi) and older Alzheimer’s treatments:

Medicare & Insurance Coverage in 2026

Medicare Coverage Policy

• The Centers for Medicare & Medicaid Services (CMS) has adopted a “Coverage with Evidence Development” (CED) framework for Alzheimer’s monoclonal antibody therapies. That means Medicare will cover FDA-approved monoclonal Alzheimer’s drugs (like donanemab) if prescribing clinicians participate in a CMS-approved registry to collect real-world data. Alzheimer’s Association+2managedhealthcareexecutive.com+2

• Medicare will pay 80% of the Medicare-approved amount (after Part B deductible) under typical policies, with the patient responsible for the remaining 20% (coinsurance). managedhealthcareexecutive.com+3cms.gov+3Alzheimer’s Association+3

• Medicare coverage only applies after the drug obtains traditional (full) approval, not just accelerated approval. managedhealthcareexecutive.com+2Alzheimer’s Association+2

• As of now, donanemab is covered by Medicare provided the prescribing doctors enroll the patient in the required registry. Alzheimer’s Association+2managedhealthcareexecutive.com+2

• CMS’s policy for Alzheimer’s drugs applies similarly to donanemab and lecanemab. managedhealthcareexecutive.com+1

Out-of-Pocket Costs & Cost Sharing

• Even with Medicare coverage, patients typically pay 20% coinsurance of the allowed amount (after deductible). cms.gov+2Alzheimer’s Association+2

• Additional expenses not always covered may include:

  • Out-of-pocket for PET scans (before and during treatment)

  • MRI scans for safety monitoring

  • Infusion administration fees (facility, nursing)

  • Genetic or biomarker testing

• Some estimates suggest Medicare enrollees could pay $5,300 per year out-of-pocket for lecanemab; similar out-of-pocket burdens might apply to donanemab depending on pricing and plan design. harmonichealth.com+4ncoa.org+4cms.gov+4

• Some Medicare Advantage or supplemental plans (Medigap) might pick up part of the coinsurance, reducing exposure.

Private Insurance & Commercial Plans

• Private insurers will likely negotiate pricing and use utilization review or prior authorization to control access. SCbio+3AIS Health+3managedhealthcareexecutive.com+3

• Commercial plans may impose step therapy, biomarker requirement, or registry enrollment obligations. AIS Health+1

• For private pay patients, donanemab's list price is $32,000/year plus additional costs (scans, monitoring) unless negotiated discounts apply. UCI MIND+4Easton Alzheimer’s Research Center+4SCbio+4

Patient Assistance, Copay Programs & Financial Support

To ease the cost burden, several assistance options may be available:

1. Lilly Support Services & Patient Assistance Program

   • Eli Lilly offers a support program for Kisunla that assists with coverage determination, care coordination, nurse navigators, and helps patients navigate insurance. SCbio+1

   • According to the company, more than 98% of eligible Medicare patients have coverage that limits or caps their out-of-pocket exposure via existing benefit structures. SCbio

2. Co-pay Assistance / Coinsurance Support

   • For commercially insured patients, there may be copay assistance programs, coupons, or foundations that help pay part of the coinsurance.

   • These programs typically exclude government-insured (Medicare) beneficiaries due to anti-kickback rules.

3. Charitable / Nonprofit Foundations

   • Alzheimer’s advocacy groups or disease-state charities may provide grants or subsidies for diagnostic or monitoring expenses (e.g., PET scan costs) or transportation.

   • Eligibility is often means-tested or limited.

4. Clinical Trials & Expanded Access Programs

   • Some patients may gain access to donanemab via clinical trials or through expanded access (compassionate use) protocols, though eligibility and supply are limited.

5. Negotiated Discounts / Manufacturer Rebates

   • Over time, payer negotiations or discounts may reduce the net effective cost below list price.

6. Cost Caps / Out-of-Pocket Maximums (Supplemental Plans)

   • Some Medicare Advantage plans or Medigap policies may impose out-of-pocket maximums or caps on drug cost sharing, helping limit exposure.

Risks, Limitations & Considerations

• ARIA (Amyloid-Related Imaging Abnormalities): Safety risk of brain swelling or microbleeds. Requires MRI monitoring. Medscape+2Alzheimer’s Association+2

• Stopping rules: Some patients may stop earlier than 18 months if amyloid is cleared; conversely, if amyloid persists, some may require full course. Lilly Investor Relations+3SCbio+3UCI MIND+3

• Uncertain long-term durability: It’s still not fully known how long benefit persists once treatment stops. UCI MIND+2Alzheimer’s Association+2

• Biomarker eligibility: Not all Alzheimer’s patients qualify — patients must show amyloid positivity (e.g. via PET) and meet clinical criteria. Easton Alzheimer’s Research Center+4Alzheimer’s Association+4UCI MIND+4

• Cost-effectiveness concerns: Some agencies (e.g. NICE in the U.K.) have questioned whether the benefit justifies cost. STAT+2bmj.com+2

• Access & equity issues: Costs of scans, infusions, and travel may limit access for rural or low-income patients.

• Regulatory & coverage uncertainty: Future policy changes (e.g. Medicare negotiation) could alter coverage or cost structures.

SEO-Driven Link Ideas & Anchor Text Suggestions

• Internal links (if on your site):

  • “Alzheimer’s disease treatment options”

  • “How Medicare Part B drug coverage works”

  • “Cost of PET scans and MRI in Alzheimer’s care”

  • “Patient assistance programs for rare disease drugs”

• External authoritative links / anchor text ideas:

  • “CMS Medicare coverage policy for Alzheimer’s drugs” → link to CMS or Alzheimer’s Association pages Alzheimer’s Association

  • “Donanemab FDA approval / Kisunla labeling” → link to Eli Lilly’s press release or UCI MIND overview UCI MIND+1

  • “Cost-effectiveness of donanemab” → link to the PMC / JAMA cost-effectiveness analysis PMC+2jamanetwork.com+2

  • “Lecanemab vs donanemab comparison” → link to Alzheimer’s Association or clinical reviews Alzheimer’s Association+2cms.gov+2

  • “Patient assistance for Alzheimer’s therapies” → link to disease foundations or drug manufacturer support pages.

Use descriptive anchor text (e.g. “Medicare Alzheimer’s coverage”) rather than generic “click here.”

20 FAQs (Frequently Asked Questions)

Below are 20 FAQs with short answers. Highlight and expand as needed for your site.

1. What is the list price of donanemab in 2024 / 2025?

   • Approximately $32,000 per year (13 infusions). BioPharma Dive+4Easton Alzheimer’s Research Center+4UCI MIND+4

2. What is the cost per vial of donanemab?

   • ~$695.65 per vial. BioPharma Dive+4Lilly Investor Relations+4SCbio+4

3. How much does 6 months of treatment cost?

   • $12,522 (approx). Lilly Investor Relations+2Medscape+2

4. How much does 18 months of treatment cost?

   • $48,696 if full 18 infusions are needed. Lilly Investor Relations+2BioPharma Dive+2

5. Will Medicare cover donanemab in 2026?

   • Likely yes under CMS’s “Coverage with Evidence Development” model, provided the prescribing physician is enrolled in the required registry and the drug has full FDA approval. Alzheimer’s Association+2Alzheimer’s Association+2

6. How much will patients pay out-of-pocket under Medicare?

   • Typically 20% coinsurance after Part B deductible, plus costs of scans, infusions, and monitoring not fully covered.

7. Does private insurance cover donanemab?

   • Some commercial plans may cover it with prior authorization, biomarker verification, and cost sharing, but coverage terms vary widely.

8. Are there copay or assistance programs for donanemab?

   • Yes — Lilly’s support program provides coverage assistance, navigation, and helps reduce patient exposure. SCbio

9. Can treatment stop early if amyloid is cleared?

   • Yes, the labeling allows stopping dosing if amyloid levels fall to minimal threshold, potentially reducing cost and duration. UCI MIND+2SCbio+2

10. How does donanemab compare to lecanemab in cost?

    • Donanemab is more expensive at baseline (~$32,000 vs $26,500), but may require fewer infusions or shorter duration. managedhealthcareexecutive.com+3UCI MIND+3BioPharma Dive+3

11. What additional costs should patients expect?

    • PET scans, MRI safety monitoring, infusion facility fees, biomarker testing, and follow-up visits.

12. Is donanemab cost-effective?

    • Modeling suggests that the economically justifiable price for one year may range from ~$44,691 to ~$80,538 depending on assumptions. PMC

13. Will cost be lower in 2026 due to competition?

    • Possibly, as payers negotiate, rivals (e.g. lecanemab) compete, and discounting becomes common.

14. Is treatment indefinite or finite?

    • It is intended as a finite-duration therapy (up to 18 months) with possibility to stop earlier.

15. What happens after treatment stops?

    • Disease progression may resume; long-term durability is under ongoing study.

16. Are scans and monitoring covered by Medicare?

    • Some are, especially if medically necessary, but patient may have some out-of-pocket costs depending on plan.

17. Can low-income patients get help paying?

    • Yes, through manufacturer assistance, nonprofit grants, and possibly state support programs.

18. Does Medicaid cover donanemab?

    • In many U.S. states, Medicaid may cover it, but policies differ by state, and registry or clinical criteria may apply.

19. Will the cost change due to Medicare drug price negotiation?

    • Possibly. Future legislation may allow Medicare to negotiate drug prices, which could reduce costs.

20. Is donanemab available outside the U.S.?

    • Yes, but pricing, reimbursement, and access depend on country and local health authorities (e.g. NICE in U.K. has questioned cost-effectiveness) STAT+2bmj.com+2

Key Takeaways & Recommendations

• In 2026, donanemab’s cost is likely to remain in the range of $32,000/year for many patients, with modest increases for inflation or negotiated pricing.

• Medicare coverage is expected, but patients must be enrolled in a CMS registry and meet eligibility criteria.

• Out-of-pocket exposure may still be substantial without supplemental insurance or assistance.

• Patient and caregiver planning is essential — inquire early about insurance coverage, assistance programs, biomarkers, and monitoring costs.

• Because donanemab is a newer, high-cost therapy, staying updated on coverage changes, legislation, and manufacturer support is critical.

🔍 Recent / Updated Developments

1. EU / EMA Approval & Europe Status

• In September 2025, the European Medicines Agency (EMA) granted marketing authorization for donanemab (Kisunla) for use in early Alzheimer’s disease. barcelonabeta.org

• Earlier, in March 2025, the EMA had recommended refusing marketing authorization, citing concerns about risks vs benefits. Wikipedia+1

• Some national health technology assessment bodies in Europe (e.g. in England & Wales via NICE) have rejected donanemab on cost-effectiveness grounds. Alzheimer's Research UK

2. Trial / Biomarker Insights

• A recent secondary analysis of the TRAILBLAZER-ALZ 2 trial showed that lower posttreatment amyloid burden correlates strongly with slower clinical decline in cognition and function. European Medical Journal

• A review in The Lancet (2025) examined lecanemab and donanemab, noting modest but meaningful slowing of decline, and suggested plasma p-tau217 as a scalable biomarker / triage marker. News-Medical

• At the 2025 AAIC conference, key takeaways highlighted that donanemab may become a standard of care in early Alzheimer’s provided safety and monitoring protocols are refined. neurologyadvisor.com

3. Medicare / CMS & Coverage Updates

• CMS’ National Coverage Determination (NCD) for monoclonal antibodies directed against amyloid (for Alzheimer’s) continues under Coverage with Evidence Development (CED). cms.gov+2cms.gov+2

• To be covered by Medicare Part B:

  1. Patients must have a diagnosis of mild cognitive impairment or mild Alzheimer’s disease dementia. cms.gov+2Medicare+2

  2. The prescribing clinician must be participating in a CMS-approved registry and submit data as required. cms.gov+2cms.gov+2

  3. After meeting the Part B deductible, patients pay 20% coinsurance of the Medicare-approved amount. Medicare+2palmettogba.com+2

• The Medicare Learning Network (MLN) newsletter in 2024 clarified that Medicare Part B covers these drugs with full FDA approval when coverage criteria are met and data is submitted. cms.gov

• ManagedHealthcareExecutive reported that CMS cleared the way for coverage of both Leqembi and Donanemab, though “strings attached” (i.e. registry, evidence development) remain. Managed Healthcare Executive

4. Insurance / Payer Policies

• Aetna considers donanemab (Kisunla) medically necessary under certain criteria for Alzheimer’s disease, with defined initial approval and continuation criteria. Aetna

• BCBSTX (BlueCross BlueShield of Texas) medical policy notes that coverage is not required when the FDA has deemed a use contraindicated or non-formulary. medicalpolicy.bcbstx.com

• UHC (UnitedHealthcare) provider policy indicates that Kisunla may be covered for AD in patients meeting policy criteria. UHC Provider

5. Global / Other Country Access

• In Australia (2025), the Therapeutic Goods Administration (TGA) approved donanemab (Kisunla) for early symptomatic Alzheimer’s disease under strict eligibility criteria. The Guardian

  • The estimated cost (drug + diagnostic/infusion/monitoring extras) could exceed AUD $80,000+ ($USD equivalent). The Guardian

  • Only a small percent of Alzheimer’s patients may qualify (due to staging, biomarkers, genetic constraints). The Guardian

• In UK / NICE review, donanemab was rejected in June 2025 for use in England & Wales on cost-effectiveness grounds. Alzheimer's Research UK

• The Alzheimer’s Research UK page notes that use & approval decisions in UK/EU remain constrained by cost, risk, and value thresholds. Alzheimer's Society+1