Medicare Part B covers Leqembi (lecanemab) for early Alzheimer’s disease, but what you’ll actually pay depends on your specific coverage. For beneficiaries with Original Medicare and no supplemental insurance, out-of-pocket costs can reach $26,500 per year—because Medicare covers 80% of the approved amount and you pay the remaining 20%. However, more than 90% of Medicare beneficiaries pay far less because they have Medigap, Medicaid, or Medicare Advantage plans that cap or eliminate their out-of-pocket expenses.
Consider a 68-year-old with Original Medicare and a Medigap Plan G: after meeting the $283 Part B deductible in 2026, the Medigap policy would cover most or all of the 20% coinsurance, bringing the annual cost down to minimal payments. Medicare approved coverage for Leqembi in July 2023 through a “coverage with evidence development” program, which means coverage continues but physicians must participate in a CMS registry to track outcomes. The drug is available as an intravenous infusion or, more recently, as a subcutaneous weekly injection. The cost differences between these routes matter, especially as the newer subcutaneous option rolls out and may offer different pricing or logistical advantages for patients who prefer to avoid repeated IV visits.
Table of Contents
- Who Qualifies for Medicare’s Leqembi Coverage?
- The Price Tag—What Does Leqembi Cost Medicare and Beneficiaries?
- Recent FDA Approvals and What They Mean for Cost and Access
- How Medicare Pays for Leqembi—The CED Program and Registry Requirements
- Infusion Center Costs and Hidden Expenses Beyond the Drug Price
- Medigap and Medicare Advantage—Why Your Plan Type Matters More Than the List Price
- Cost Assistance and Payment Options When Out-of-Pocket Costs Loom
Who Qualifies for Medicare’s Leqembi Coverage?
To receive Medicare coverage for Leqembi, you must have mild cognitive impairment (MCI) or mild dementia stage Alzheimer’s disease with documented beta-amyloid plaque confirmed by brain imaging—either a PET scan or an amyloid-targeting MRI. You also need to be enrolled in Medicare (Part A and B, typically), and your healthcare provider must be willing to participate in the CMS registry that tracks patient outcomes during treatment. This participation requirement exists because Medicare wants to gather real-world data on how the drug performs in routine care, not just in clinical trials.
The brain imaging requirement is a significant hurdle that many people overlook. You cannot start Leqembi based on cognitive symptoms alone; your neurologist or memory care specialist must order and interpret imaging that confirms amyloid buildup. If you’ve never had this imaging, scheduling it may add weeks or months to the process before treatment can begin. Some patients discover they have cognitive changes but no significant amyloid on imaging, which means they wouldn’t qualify for Leqembi even if they had other signs of decline—because Leqembi works specifically on amyloid, not other pathologies.
The Price Tag—What Does Leqembi Cost Medicare and Beneficiaries?
The annual list price for Leqembi stands at approximately $27,439 per year for the standard intravenous dosing schedule (165 lb patient receiving twice-monthly infusions). However, Medicare negotiates rates with manufacturers, and beneficiaries don’t pay the full list price—they pay a percentage of Medicare’s approved amount. For someone with Original Medicare and no supplemental coverage, that 20% coinsurance obligation typically comes to around $26,500 annually, which equals roughly $14.50 per day. In practical terms, a beneficiary with Original Medicare alone would pay the annual $283 Part B deductible, then 20% of each visit’s cost, accumulating over the two-year treatment course. The problem is that $26,500 per year far exceeds the spending limits built into most fixed incomes.
This is why supplemental coverage makes such a dramatic difference. A Medicare beneficiary with Medigap coverage pays little to nothing out-of-pocket, while someone with a Medicare Advantage plan might face a formulary tier copay—often $0 to $500 per year depending on the plan. If you’re uninsured or enrolled in Original Medicare without Medigap, you need to explore the cost assistance programs offered by Eisai (the manufacturer) through their LEQEMBI Companion patient support program, which may cover copays or other out-of-pocket costs based on income. The emerging subcutaneous weekly injection formulation (Leqembi IQLIK) approved by the FDA in August 2025 may eventually shift costs and convenience, but final pricing for the subcutaneous form has not been widely publicized. Preliminary information suggests it may have similar per-dose costs but could reduce infusion center overhead, which theoretically might lower Medicare’s approved amount over time. For now, assume the intravenous route represents the cost baseline.
Recent FDA Approvals and What They Mean for Cost and Access
In January 2025, the FDA approved an intravenous maintenance-dosing formulation for Leqembi, allowing less frequent infusions after an initial loading period. Then in August 2025, the FDA approved a subcutaneous weekly injection (Leqembi IQLIK at 360 mg) for maintenance therapy, which launched in October 2025. This represents a significant shift in how the drug is administered—instead of traveling to an infusion center twice monthly, patients can self-inject or have a nurse administer the drug once per week in an outpatient or home setting. The subcutaneous formulation potentially offers convenience and cost advantages.
Home-based care avoids the overhead of infusion center visits and staff, which could eventually lower the Medicare-approved reimbursement rate. Additionally, a pending supplemental BLA for the subcutaneous weekly starting dose has Priority Review status, with an FDA action date of August 24, 2026. Once approved, patients could initiate treatment with weekly subcutaneous injections rather than starting with intravenous loading doses. This streamlines the treatment pathway but also means you should check with your Medicare plan about current coverage policies, because coverage rules for the newer subcutaneous form may differ from the established intravenous route.
How Medicare Pays for Leqembi—The CED Program and Registry Requirements
Medicare’s coverage through the “coverage with evidence development” program is conditional on your physician’s participation in a CMS-facilitated registry. This is not a barrier that prevents coverage; it’s a requirement that ensures your care team is monitoring you systematically. Your neurologist or dementia specialist must enroll in the registry, submit baseline information about your diagnosis and imaging results, and then report your outcomes at defined intervals. This data collection allows CMS to understand whether Leqembi is delivering the expected cognitive benefits in real-world patients outside of clinical trials.
In practice, this means your doctor’s office will need to complete some additional paperwork and consent forms when you start Leqembi. You’ll likely have more structured follow-up visits than you would for other Alzheimer’s treatments, because the registry collects cognitive testing results and any adverse events. The registry requirement does not increase your out-of-pocket costs; Medicare’s payment to your provider is the same whether or not you’re in a CED program. However, the administrative burden on your healthcare provider may mean that some smaller practices decline to offer Leqembi, so patients in rural areas or underserved regions sometimes travel to larger medical centers for this treatment.
Infusion Center Costs and Hidden Expenses Beyond the Drug Price
The $27,439 annual list price for Leqembi covers the drug itself, but it does not include the cost of administering the intravenous infusion. Medicare reimburses infusion centers separately for the procedure—typically $100 to $300 per visit depending on the setting (hospital outpatient, independent center, or physician office) and the complexity of monitoring required. For a patient receiving twice-monthly infusions over 24 months, that’s roughly 48 visits, which could add $5,000 to $15,000 in facility fees on top of the drug cost. However, these facility costs are included in Medicare’s overall reimbursement calculation, so the 20% coinsurance you pay as a beneficiary theoretically includes your share of these fees.
One hidden consideration is that Leqembi requires infusion center capacity, and not all centers stock it or have experience administering it. Travel to a specialized center can mean parking, meals, and time away from home or caregivers, which creates indirect costs. Some patients arrange for home infusions through specialty pharmacies, which may be covered by Medicare Advantage plans but could carry additional copays. The newer subcutaneous weekly injection sidesteps much of this problem, but until that formulation is widely available and insurers have updated their coverage policies, the intravenous route remains the standard, and infusion logistics remain part of the real-world cost equation.
Medigap and Medicare Advantage—Why Your Plan Type Matters More Than the List Price
The difference between Original Medicare, Medigap, and Medicare Advantage is the single largest factor determining what you pay for Leqembi. Original Medicare covers 80% of the approved amount, leaving you responsible for 20%—a substantial annual liability. Medigap plans (supplemental insurance) typically cover this 20% coinsurance, so your out-of-pocket cost drops to the plan’s premiums plus any uncovered services. A beneficiary with Medigap Plan G, for instance, would pay only the $283 Part B deductible in 2026, then essentially nothing for Leqembi treatment itself (beyond ongoing Medigap premiums, which average $100 to $200 per month depending on age and location).
Medicare Advantage plans operate differently: they combine Part A, B, and D coverage under one private plan and typically include a formulary that determines copays or coinsurance for specific drugs. Some Medicare Advantage plans place Leqembi on a specialty tier with high copays ($500 to $1,500 per month or per infusion), while others may have lower costs if the plan has negotiated preferential pricing with the manufacturer. You need to check your specific Medicare Advantage plan’s formulary or call customer service to learn whether Leqembi is covered and at what cost. A plan that doesn’t cover Leqembi at all or places it on an expensive tier might motivate you to switch during the annual open enrollment period (October 15 to December 7), though late switching means waiting until the following year to enroll.
Cost Assistance and Payment Options When Out-of-Pocket Costs Loom
If you face steep out-of-pocket costs for Leqembi, the manufacturer (Eisai) operates the LEQEMBI Companion patient support program, which offers copay assistance, coinsurance support, and even free or reduced-cost medication for eligible uninsured and underinsured patients. Income thresholds for the program are typically set at or near 400% of the federal poverty level, which captures most middle-income beneficiaries facing genuine hardship. Applying for copay assistance through the program usually requires a brief application submitted by your healthcare provider’s office, and approval typically comes within days to a week. Additionally, Medicaid may cover Leqembi for beneficiaries who qualify for both Medicare and Medicaid (“dual eligible”).
Medicaid rules vary by state, but in states with generous dual-eligible programs, Medicaid can cover the Part B deductible and coinsurance, reducing your costs to zero. Aging and disability resource centers in your area can help you determine whether you qualify for Medicaid. Finally, some religious organizations, community health foundations, and disease-specific nonprofits (like the Alzheimer’s Association) occasionally offer emergency grants for medication costs, though availability is limited and competitive. Before you assume you cannot afford Leqembi, contact your healthcare provider’s patient advocate or the Eisai support program to explore what assistance exists in your situation.
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