Insurers Refusing Coverage for Alzheimer’s Drug Leqembi, Despite FDA Approval

Several insurers in New York, North Carolina, and Pennsylvania have decided not to cover the cost of the drug Leqembi, a treatment for Alzheimer’s disease, citing it as experimental, according to reports from the Associated Press. This is in contrast to Medicare, which has announced that it will cover the drug for enrollees with mild cognitive impairment or mild dementia due to Alzheimer’s disease, with the condition that the patient has documented evidence of beta-amyloid plaques in the brain and follows appropriate clinical care. However, many younger individuals who develop early-onset Alzheimer’s in their 40s, 50s, or even 30s may be impacted the most, as they may not have the resources outside of insurance to access the expensive drug, said Dr. Greg Jicha, director of clinical trials at the University of Kentucky. Without coverage for Leqembi, some patients may have to wait until they are 65 and eligible for Medicare, but by then, their symptoms may be so severe that they become ineligible for the drug. The cost of being treated with Leqembi is estimated to run from $80,000 to $90,000 per year, including screening, genetic testing, and follow-up tests. This high overall cost may make it harder for individuals without insurance coverage to access early treatment. Leqembi is the first drug approved by the FDA to slow cognitive decline in Alzheimer’s disease patients, although its benefits are modest.