CMS has stated that it will only cover Leqembi for Medicare patients who meet all of the following criteria. These requirements include:
Being diagnosed with mild cognitive impairment or mild dementia
Having documented evidence of beta-amyloid plaque on the brain, which can be commonly found in those with Alzheimer’s
Having a doctor who participates in a qualifying registry and who maintains proper follow-up care alongside an appropriate clinical team
To document evidence of beta-amyloid plaque, patients will typically need to get additional testing done to see if they have it in their brain. These tests include either a lumbar puncture (also called a spinal tap) or a PET scan. Find Medicare Plans in 3 Easy Steps We can help find the right Medicare plans for you today However, it is important to ensure Medicare will cover any brain scans or other tests and services needed to get Leqembi treatments.
Those with more advanced forms of Alzheimer’s disease or more severe degenerative cognitive symptoms likely will not qualify for Leqembi treatment or coverage through Medicare.