Millions of people have been paying that much out of pocket when their insurance companies have denied their weight loss shots. People with the means, and the genetic disposition for developing ALZ + likely drug response, will pay large sums to preserve their brain health.
Outside of prophylactic use, if the drug is only approved for the 30-35% who receive cure-like benefit (and I think that sort of restriction is unlikely), Anavex will be able to charge several multiples of 10k/yr and insurance companies / governments will pay it.