Negotiations between the National Health Service (NHS) and two pharmaceutical companies over pricing for the first drugs shown to slow Alzheimer’s disease have intensified, raising hopes for expanded patient access. Eli Lilly and Company, the US manufacturer of donanemab, has entered commercial discussions with NHS England following a recent similar move by Japanese firm Eisai, maker of lecanemab. Both drugs represent a new class of treatments aimed at slowing cognitive decline in patients with early-stage Alzheimer’s.
Clinical trials in 2023 reported that donanemab reduces cognitive deterioration by approximately 35 percent, while lecanemab was shown to lower the risk of decline by 27 percent. These findings marked a significant departure from previous therapies that primarily targeted symptoms rather than disease progression.
Despite regulatory approvals—Britain licensed lecanemab in August 2024 and donanemab months later—both treatments faced initial rejection by the National Institute for Health and Care Excellence (NICE) on the grounds that their cost did not justify the clinical benefits. NICE highlighted concerns over the comprehensive expenses related to drug acquisition, administration, and patient monitoring. Both manufacturers have contested these decisions, arguing that NICE underestimated the drugs’ positive impact on patients and unpaid caregivers while overestimating delivery costs.
Subsequently, NICE’s independent appraisal committee has revised some assumptions, reducing estimated NHS delivery expenses, assigning greater importance to the burden on unpaid carers, and raising the threshold used to assess cost-effectiveness. Nevertheless, disagreements remain regarding the total cost implications of implementing the treatments at scale.
Earlier this month, NICE invited both companies into commercial negotiations with NHS England in an effort to reach an acceptable price point that would support routine NHS availability. Eisai publicly confirmed its participation in these discussions, followed by Eli Lilly.
Amid these developments, political attention has also focused on Alzheimer’s care. Andy Burnham, a senior political figure, has pledged to address the broader social care challenges facing Britain by expediting a review led by Baroness Casey. Casey has criticized the current evaluation standards for medicines, noting they insufficiently value older populations and the benefits of breakthrough treatments. She observed that new drugs are frequently deemed “too expensive” for the relatively modest benefits they provide, while advocating for broader clinical trial coverage.
Hilary Evans-Newton, chief executive of Alzheimer’s Research UK, emphasized the importance of making such treatments accessible. She noted that while social care reform is critical, it alone cannot adequately address the scale of dementia-related challenges. “Scientific breakthroughs only matter if they reach patients,” she said, highlighting the potential for these therapies to extend patient independence and lessen pressures on families, healthcare services, and social care systems.
Nearly one million people in the United Kingdom live with dementia, with Alzheimer’s disease accounting for the majority of cases. A spokesperson for Eli Lilly acknowledged ongoing differences with NICE’s prior assessments but affirmed the company’s commitment to exploring all avenues toward ensuring access for eligible individuals in England.