Two FDA-approved medications can slow early Alzheimer's disease progression, and manufacturers offer substantial copay assistance programs—but access and affordability vary sharply by insurance type, programs change, and early treatment has time value. Understanding your eligibility and acting soon can unlock savings of thousands of dollars and access to medications otherwise unaffordable.
The savings landscape for dementia care is shifting fast. New drugs, new insurance coverage rules beginning in 2026, and manufacturer assistance programs with built-in eligibility limits create a narrow window for the lowest out-of-pocket costs. Reading this guide helps you identify which savings path applies to your situation.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- The Two New Alzheimer's Medications Now Available
- Copay Assistance Eligibility: The Critical Medicare Exclusion
- Medicare Part D 2026: New $2,100 Out-of-Pocket Cap
- What Medicare Does Not Cover: Residential Memory Care and Long-Term Costs
- Free Treatment Access Through Clinical Trials
- Amyloid-Related Imaging Abnormalities: The Safety Monitoring Requirement
- Frequently Asked Questions
The Two New Alzheimer's Medications Now Available
Two monoclonal antibodies targeting amyloid can slow cognitive decline in early Alzheimer's disease. Leqembi (lecanemab), approved by the FDA in July 2023, is administered by IV infusion for patients with mild cognitive impairment or mild dementia stage with confirmed amyloid buildup. A January 2025 update expanded access with once-monthly IV maintenance dosing; July 2026 added subcutaneous injections, which may ease access and adherence. Kisunla (donanemab), approved July 2, 2024, treats the same patient population.
The drug costs approximately $32,000 per year before insurance. Clinical trial data showed 69% of participants stopped treatment within 18 months after their amyloid cleared, suggesting a defined treatment window rather than lifelong therapy. Eligibility for both requires a diagnosis of early symptomatic Alzheimer's disease and imaging confirmation of amyloid pathology. Your neurologist or memory clinic orders the diagnostic PET or amyloid CSF biomarker test. If you qualify, treatment timing affects which copay program you access—and that difference can save thousands of dollars.
Copay Assistance Eligibility: The Critical Medicare Exclusion
Eisai and Lilly offer significant copay assistance for these drugs, but **the programs do not apply to medicare beneficiaries.** Eisai's copay assistance for Leqembi caps out-of-pocket costs at $10,000 per year and may reduce your copay to $0 per infusion if you have commercial insurance. Lilly's savings card for Kisunla offers $0 copay for commercially insured patients, up to $9,450 per year for up to 15 infusions.
If you have commercial insurance, verify your plan covers the medication before choosing Leqembi or Kisunla. Some plans may require prior authorization or restrict access to specific sites of care. Ask your neurologist's office to confirm coverage before your first infusion appointment.
- *These programs explicitly exclude Medicare, Medicaid, Medigap, VA, DoD, and TRICARE enrollees.** Medicare beneficiaries do not qualify because federal law bars drug manufacturers from providing copay assistance to patients on federal insurance programs. If you are on Medicare and cannot afford out-of-pocket costs, the relevant path is Part D coverage (see Section 3) or enrollment in clinical trials (see Section 5).
Medicare Part D 2026: New $2,100 Out-of-Pocket Cap
Beginning in 2026, Medicare Part D introduces a new annual cap of $2,100 on out-of-pocket drug costs. After you spend $2,100 on covered medications (copays, coinsurance, and deductibles combined), Medicare pays the remainder of your drug costs for the calendar year. This cap applies to both Leqembi and Kisunla if your plan includes them. For Medicare beneficiaries without employer retiree coverage or Medicaid, this cap is the primary path to affordability.
At a nominal copay of $50–$200 per infusion, six to twelve infusions per year could exceed $2,100 quickly, after which costs drop to zero. However, not all Medicare Part D plans cover both drugs; some require step therapy or deny coverage entirely. Before 2026 begins, review your Part D formulary or call your plan to confirm which drug is covered. If your plan excludes both, you can switch plans during open enrollment (October 15–December 7 annually) to one that includes them. Plan changes are usually most favorable for people enrolling for the first time or switching specifically for drug coverage.
What Medicare Does Not Cover: Residential Memory Care and Long-Term Costs
These medications address cognitive decline but do not replace other dementia care costs. **Medicare Part A and B do not cover residential memory care facilities or continuing assisted living.** Medicare covers acute hospital stays, short-term skilled nursing after hospitalization, and a Care Planning benefit for cognitive impairment, but not the residential or custodial environment itself. The median cost of memory care facility placement is $8,019 per month in 2026. Medicaid covers long-term custodial care in these settings, but eligibility requires spending down personal assets (typically to $2,000 for a single person) and meeting income thresholds.
Each state's Medicaid program has different rules and timelines. Medications that slow cognitive decline may defer residential placement by months or years, making early treatment financially and personally valuable. Delaying disease progression, even modestly, can preserve independence and reduce the years of facility care your family must fund. Discussing early diagnosis and access to these drugs with your family is part of broader dementia care planning.
Free Treatment Access Through Clinical Trials
If you do not qualify for copay assistance and cannot afford Part D out-of-pocket costs or medication access otherwise, Alzheimer's Association's TrialMatch tool matches patients with free clinical trial access. Clinical trials offer both investigational treatments and standard-of-care medications at no cost to participants. Typical trial eligibility includes age 50 or older, a diagnosis of early symptomatic Alzheimer's or cognitive impairment, availability of a study partner, stable overall health, and willingness to complete serial brain MRI scans.
ApoE4 genetic testing is often required. Trial availability varies by geography and shifts as recruitment closes and new studies open. Clinical trial participation requires time commitment for visits and scans, but it provides medication access without cost barriers and contributes to research on treatments and side effects. If copay assistance or Part D coverage are not viable, this path is worth exploring with your neurologist.
Amyloid-Related Imaging Abnormalities: The Safety Monitoring Requirement
Both Leqembi and Kisunla carry a known safety concern: amyloid-related imaging abnormalities, or ARIA. These asymptomatic or symptomatic changes—edema (swelling) or microhemorrhages in the brain—occur in 12–22% of patients on these drugs. Most patients experience no symptoms, but headache, confusion, dizziness, or seizures can occur if ARIA is symptomatic. Risk is higher in people carrying the ApoE4 genetic variant, those with baseline brain microhemorrhages on imaging, and those on higher drug doses.
Managing ARIA requires serial MRI monitoring to catch asymptomatic changes early. These MRI scans are typically covered by insurance but add time and coordination between your neurologist and imaging center. Before starting Leqembi or Kisunla, discuss ARIA risk and the monitoring plan with your neurologist. If you have uncontrolled high blood pressure, a history of microstrokes, or other conditions affecting small blood vessels, ARIA risk may be higher, and your doctor may recommend caution or additional baseline imaging. This is a reason to begin treatment soon after diagnosis, when you are medically stable and can establish reliable MRI monitoring.
Frequently Asked Questions
Do I have to take Leqembi or Kisunla once I start?
No. Clinical trial data showed 69% of Kisunla patients stopped after amyloid cleared from the brain, typically within 18 months. Stopping a drug is a discussion between you and your doctor based on MRI findings and whether amyloid has fully cleared.
If I have Medicare, can I ever get manufacturer copay assistance?
No. Manufacturer copay programs legally cannot apply to Medicare, Medicaid, VA, TRICARE, or DoD beneficiaries. Your path is Part D coverage, the Part D out-of-pocket cap, or clinical trial enrollment.
What if my Part D plan doesn't cover Leqembi or Kisunla?
You can switch plans during open enrollment (October 15–December 7) to a plan that does. You can also ask your doctor if your plan covers similar drugs or if prior authorization is required.
How long does it take to get amyloid cleared?
Typically 6 to 18 months on consistent treatment with either drug, but the timeline varies by person and initial amyloid burden. Your doctor monitors progress with periodic MRI or CSF biomarker testing.
