Leqembi (lecanemab-irmb), a drug for early Alzheimer's disease, has a U.S. list price of $26,500 per year and Medicare Part B coverage only when strict diagnosis and registry rules are met. Verify your disease stage, amyloid proof, prescribing clinician, and 20% coinsurance plus separate testing and monitoring bills.
The drug is not for all dementia. It is indicated only for mild cognitive impairment or mild dementia due to Alzheimer's. Treatment also requires confirmed amyloid-beta in the brain before the first dose.
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
- Who qualifies for treatment?
- What does Medicare require for coverage?
- What will you pay per year?
- Which extra bills must you verify?
- What safety and dosing options affect planning?
Who qualifies for treatment?
Leqembi is for adults with early Alzheimer's disease. That means mild cognitive impairment or mild dementia linked to Alzheimer's, not moderate or advanced dementia. A second check is brain amyloid. Patients need documented amyloid-beta pathology before starting treatment.
Without that proof, coverage and prescribing stop. Age or memory symptoms alone do not qualify. The diagnosis must tie the cognitive change to Alzheimer's. Ask your clinician to record both stage and cause in writing.
What does Medicare require for coverage?
After traditional approval, the Centers for Medicare & Medicaid Services broadened Medicare coverage for patients who meet three checks, described in the Medicare coverage statement. The patient must be enrolled in Medicare, have mild impairment or mild dementia with documented brain amyloid, and receive care from a clinician in a CMS qualifying registry. The registry rule matters for families. If the doctor does not take part, Medicare coverage does not apply.
Confirm participation before scheduling tests or infusions. Traditional approval followed a confirmatory trial. According to the U.S. Food and Drug Administration, the agency converted Leqembi from accelerated to traditional approval on July 6, 2023, after benefit was verified, as detailed in the FDA approval notice. That change opened the broader coverage path.
What will you pay per year?
Eisai set the U.S. wholesale list price at $26,500 per year for an average-weight patient, according to Healthcare Dive reporting on the company statement, described in the price report. The company said the price sat below its modeled $37,600 societal value to promote access. Under Medicare Part B, patients typically owe 20% coinsurance after the Part B deductible.
On list price, that is about $5,300 per year for the drug alone. Medigap or other secondary insurance may cover some or all of that share. Weight, dose changes, and infusion-site fees affect the final bill. Ask for a written estimate based on actual weight and site. Also confirm what your secondary plan pays.
Which extra bills must you verify?
The drug price is only part of the total. Families must verify amyloid PET or spinal-fluid testing, biweekly infusion administration, and serial brain MRIs separately. Each service carries its own Part B cost-sharing.
Those extras repeat over time. Infusion visits occur every two weeks for the IV form. MRIs occur at baseline and at scheduled follow-up points. Get these answers before consent:.
- Which amyloid test is ordered, and what is its out-of-pocket cost
- Where infusions occur, and what facility fee applies
- How many MRIs are planned in year one, and where they are billed
What safety and dosing options affect planning?
Leqembi carries a boxed warning for amyloid-related imaging abnormalities, called ARIA. ARIA can cause brain swelling or bleeding and requires baseline and periodic MRI monitoring. The FDA later recommended additional earlier MRI checks to catch swelling-type ARIA sooner. Report headache, confusion, vision change, dizziness, nausea, or trouble walking right away.
Those symptoms can signal ARIA. Do not skip a scheduled MRI because you feel well. For eligible early-Alzheimer's patients, FDA in 2025 approved Leqembi Iqlik as a once-weekly under-the-skin initiation dose. It gives an at-home autoinjector alternative to starting with biweekly IV infusions. Ask whether your center offers it and how home dosing changes visit fees, training, and monitoring.
