Does Medicare cover Alzheimer's drugs like Leqembi?

Which Alzheimer's drugs does Medicare cover?

Medicare Part B may cover FDA-approved monoclonal antibodies that target beta-amyloid plaques for treating Alzheimer's disease, like Leqembi (generic name lecanemab) and Kisunla (generic name donanemab). Monoclonal antibodies may slow or delay symptoms of Alzheimer's disease, but they don't cure or reverse the disease. The drug is given intravenously (through a vein) in a provider's office or other outpatient setting.

Who qualifies for Medicare coverage of Leqembi or Kisunla?

Your provider must confirm you have beta-amyloid plaques consistent with Alzheimer's disease, and must diagnose you with one of the following:

• Mild cognitive impairment due to Alzheimer's disease
• Mild dementia due to Alzheimer's disease

Why does Medicare require a registry?

Medicare coverage of these monoclonal antibodies requires your doctor or other provider to collect evidence about how well the drugs work for a qualifying study or registry. Medicare.gov says the information your provider collects helps answer treatment questions and describes how well the drug works for you.

CMS issued a National Coverage Determination on April 7, 2022, that covers FDA-approved monoclonal antibodies directed against amyloid under Coverage with Evidence Development, for patients with a clinical diagnosis of mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's disease dementia. CMS lists the studies that meet the requirements for coverage under Coverage with Evidence Development; for one of them, prescribing clinicians or their staff submit data through the CMS National Patient Registry at the first baseline treatment and every six months for up to 24 months.

What do I pay for Alzheimer's drugs with Medicare?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for Part B-covered monoclonal antibodies. You may need scans and tests before or during treatment that might add to your costs, so talk to your provider for more information.

Doctors, other health care providers and pharmacies must accept assignment for Part B-covered drugs, so they should never ask you to pay more than the coinsurance or copayment for the Part B-covered drug itself. With Original Medicare, you can choose to buy a Medigap (Medicare Supplement Insurance) policy to help pay out-of-pocket costs like your 20% coinsurance.

What if I don't meet Medicare's Part B criteria?

If you don't meet the Part B coverage criteria for an FDA-approved monoclonal antibody for treating early Alzheimer's disease, your Medicare drug plan (Part D) might cover it. Contact your plan for more information. To get evaluated, Medicare Part B covers a cognitive assessment and care plan visit; see what Medicare covers for dementia care.

Does Medicare Advantage cover Alzheimer's drugs?

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and plans may also offer extra benefits; rules and costs vary by plan. A Medicare Advantage Plan may require you to get approval (prior authorization) before it covers certain services or supplies and to use providers in its network, so check with your plan before you start treatment.