Medicare is beginning to cover some of the newest Alzheimer’s treatments, but the landscape is complex and evolving as these therapies are very recent and come with significant considerations. One of the most notable advances is the FDA approval of Leqembi, an injectable drug designed to target and clear amyloid beta plaques in the brain, which are believed to contribute to Alzheimer’s disease progression. Medicare now offers coverage and reimbursement for Leqembi treatment for eligible individuals, specifically those diagnosed with mild cognitive impairment or early dementia due to Alzheimer’s, confirmed by brain imaging or spinal fluid tests. This marks a significant step toward making cutting-edge treatments more accessible to the aging population affected by Alzheimer’s.
Leqembi works by targeting toxic amyloid beta protofibrils and plaques, helping to slow cognitive and functional decline by about 27% over 18 months in early-stage patients. The treatment is administered via a subcutaneous autoinjector, which can be used at home, making it more manageable for patients and caregivers. Long-term data suggest that early and sustained treatment with Leqembi may prolong functional independence and cognitive benefits even after amyloid plaques have been cleared. However, this treatment is not suitable for everyone; it requires confirmation of amyloid plaques and is intended for early-stage disease, not advanced dementia.
Alongside Leqembi, other anti-amyloid drugs like donanemab have also been approved, showing promise in slowing disease progression. However, these drugs carry risks such as brain swelling and hemorrhages, known as ARIA (amyloid-related imaging abnormalities), which require careful patient selection and monitoring. Patients often undergo extensive cognitive assessments, PET scans, and genetic testing to determine if they are good candidates for these therapies. The treatments are also costly, with annual prices ranging from around $26,500 to $32,000, plus additional expenses for required brain scans and monitoring.
Medicare’s coverage decisions for these new Alzheimer’s treatments have been subject to scrutiny and debate. The Centers for Medicare & Medicaid Services (CMS) has sometimes used broad national coverage determinations that restrict access to entire classes of Alzheimer’s drugs despite FDA approval. This has led to delays and uncertainty for patients and providers. There are calls for greater transparency and timeliness in CMS coverage decisions to ensure that beneficiaries can access medically necessary treatments without prolonged waits.
In addition to drug coverage, Medicare has introduced programs to support caregivers of people with dementia, recognizing the immense burden o
