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Despite all the excitement surrounding the FDA’s approval on Monday of a controversial treatment for Alzheimer’s disease, the drug won’t be flowing into a lot of patients’ arms anytime soon.

Aduhelm, made by Cambridge-based Biogen, poses an array of thorny issues that have yet to be untangled, including how to provide the monthly hour-long infusions and whether insurers will pay for the drug despite the $56,000 annual price tag. And some consumers may face hefty out-of-pocket charges, which could make them think twice about taking a drug with known risks and uncertain benefits.

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