Price talks and provincial drug plan decisions still stand between approval and access
Neither of the two Alzheimer’s disease-modifying therapies (DMTs) approved in Canada has cleared price negotiation or provincial and territorial drug plan decisions, a step that may take another 12 to 18 months based on past drug negotiations.
That timeline appears in Building equitable access to Alzheimer’s disease-modifying therapies in Canada, published by the Alzheimer Society of Ontario.
Health Canada approved lecanemab in October 2025 and donanemab in April 2026.
Canada’s Drug Agency (CDA) recommended on August 31 that lecanemab be reimbursed by public drug plans for eligible patients subject to specified conditions, and the report dates a recommendation supporting reimbursement of donanemab, also with conditions, to this Wednesday.
Price negotiations run through the pan-Canadian Pharmaceutical Alliance process for new drugs before each jurisdiction sets its own terms.
Cost of treatment or lack of public drug-plan coverage was selected by 14 of 15 respondents to a pre-roundtable survey conducted between June 26 and July 13.
Long wait times for specialist referral were selected by 10, limited access to a family physician or primary care provider by nine, and limited availability of diagnostic testing such as CSF, MRI or PET by eight.
Asked to name the three most important investments needed, 12 of 14 respondents selected securing public drug-plan coverage and reimbursement.
Expanding diagnostic capacity including biomarker testing and imaging was selected by seven, and building primary care capacity and investing in care coordination and navigation by five each.
No respondent rated any area of the health system fully ready to support equitable implementation.
Health equity considerations were rated not ready by 71 percent of the 14 respondents to that question, with primary care capacity, care coordination and navigation supports, and data systems to monitor access and outcomes each at 64 percent.
No respondent rated the current health technology assessment (HTA) process very well suited to evaluating DMTs.
Among the 14 who answered, 43 percent called it not very well-suited and 14 percent not well-suited at all.
Cathy Barrick, CEO of the Alzheimer Society of Ontario, said in the society’s release announcing the report that everyone needs dementia care and support, whether or not they are eligible for a disease-modifying therapy.
Public coverage of a treatment “is essential, but it is only one part of access,” she said, pointing to timely assessment, testing, guidance and coordinated follow-up.
The report sets out seven calls to action covering public reimbursement and funding of a comprehensive dementia care pathway, coordinated dementia care infrastructure, HTA reform, early-diagnosis capacity, primary care resourcing, public and provider education, and co-design with people living with dementia.
Current DMTs are indicated for eligible people with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease.
Biomarker testing confirms the presence of amyloid, MRI scans assess risk before treatment and monitor for side effects during it, and treatment is delivered by infusion with continued specialist oversight.
The journey from first symptoms to a formal dementia diagnosis has been estimated to take an average of 3.5 years, the report says, citing a 2025 systematic review in the International Journal of Geriatric Psychiatry.
Nearly 20 percent of Canadians do not have a regular primary care provider, according to 2025 Canadian Institute for Health Information data on primary care access cited in the report.
In Ontario, more than 200,000 care partners support people living with dementia, providing an estimated 5.75m hours of unpaid care each week, often alongside work, family and other obligations.
The July 13, 2026 roundtable brought together 12 participants from primary care, neurology, geriatric medicine and community service agencies across Ontario, Quebec and British Columbia.
People living with MCI or early Alzheimer’s disease and care partners did not participate directly.
The initiative was supported through a grant from Eli Lilly Canada, and the society states it retained full editorial control.
