How was Zolgensma's $2.125 million price set?
Novartis assembled academics and consultants to justify a value-based price against Spinraza; executives floated $4–5 million before launch; and ICER's founder described investor pressure to set a high price to establish a gene-therapy precedent.
Novartis set a list price of $2.125 million, making Zolgensma the first US drug over $1 million and the world's most expensive medicine at the time. ProPublica reported that Novartis assembled academics and consultants to develop a value-based case, comparing Zolgensma with Biogen's SMA drug Spinraza, which costs about $750,000 in its first year. One co-authored study concluded the therapy would be cost-effective at up to $5 million, and executives had publicly floated $4 million to $5 million. ICER's founder described pressure from Wall Street, saying investors wanted a high price to set a precedent. Novartis presented the final figure as half the cost of ten years of Spinraza, and offered payers the option of annual instalments of $425,000 over five years and outcomes-based agreements.