Yes, Medicare covers Leqembi (lecanemab), but with specific conditions. Since July 2023, when the FDA granted traditional approval, broader Medicare coverage has been available for this Alzheimer’s drug. However, coverage comes with eligibility requirements, a registry participation mandate, and out-of-pocket costs that can still be significant.
How Medicare Covers Leqembi
Medicare covers Leqembi under Part B, which handles physician-administered drugs. Because Leqembi is given as an intravenous infusion at a medical facility, it falls under Part B rather than Part D (the prescription drug benefit). This distinction matters for your costs, which we’ll get to below.
The coverage falls under a framework called “coverage with evidence development,” or CED. In practical terms, this means Medicare will pay for the drug, but your prescribing doctor must participate in a data registry. Your clinical team submits information about your treatment at baseline and every six months for up to two years (five total check-ins). This requirement exists because CMS wants real-world data on how these amyloid-targeting drugs perform outside of clinical trials. If your doctor’s practice isn’t enrolled in a qualifying registry, Medicare won’t cover the treatment.
Who Qualifies for Coverage
Not every Alzheimer’s patient is eligible. Medicare limits coverage to people in the early stages of the disease. Specifically, your doctor must diagnose you with one of two conditions:
- Mild cognitive impairment due to Alzheimer’s disease: noticeable memory and thinking problems that don’t yet interfere significantly with daily life
- Mild dementia due to Alzheimer’s disease: cognitive decline that has begun affecting daily functioning, but is still in an early stage
On top of the cognitive diagnosis, you need documented evidence of amyloid beta plaques in the brain. This is typically confirmed through a PET scan or a spinal fluid test. The plaque confirmation is non-negotiable. Without it, Medicare will not cover the drug regardless of your symptoms or clinical diagnosis. Medicare does provide conditional coverage for amyloid PET scans under its own evidence development program, so the diagnostic imaging itself can be covered.
What You’ll Pay Out of Pocket
Leqembi carries a list price of roughly $26,500 per year. Under Original Medicare Part B, you’re typically responsible for 20% of the Medicare-approved amount after meeting your annual Part B deductible. That means your share could run approximately $5,300 annually for the drug alone, not counting the costs of infusion visits, monitoring MRIs, and the diagnostic testing to qualify.
If you have a Medigap (Medicare Supplement) policy, it may cover some or all of that 20% coinsurance depending on your plan type. Plans C, F, and G, for example, generally cover Part B coinsurance in full. If you don’t carry supplemental insurance, the out-of-pocket burden can be substantial. Eisai, the drugmaker, does offer a patient assistance program, which may help offset costs for those who qualify financially.
Medicare Advantage Plans May Differ
If you’re enrolled in a Medicare Advantage plan rather than Original Medicare, the same national coverage determination applies. Your plan must cover Leqembi under the same conditions. However, Medicare Advantage plans can require prior authorization before approving treatment, which Original Medicare generally does not. This means you may face additional paperwork and potential delays. Some Medicare Advantage plans may also limit which facilities or providers you can use, so check with your plan before starting the process.
What Treatment Looks Like
Leqembi is administered as a one-hour intravenous infusion every two weeks. That’s 26 infusions per year, each requiring a visit to an infusion center or medical facility equipped to handle it. Your clinical team will also schedule regular brain MRIs to monitor for side effects, particularly a condition called ARIA, which involves temporary swelling or small bleeds in the brain. These monitoring scans are part of the standard treatment protocol and are also covered under Part B.
The commitment is real. Between biweekly infusions, periodic MRIs, and the registry reporting your doctor handles on the back end, Leqembi treatment involves frequent contact with your medical team for at least the first two years. For many patients, having a caregiver who can help with transportation and appointment management is a practical necessity.
Steps to Get Started
If you or a family member is considering Leqembi, the path to Medicare-covered treatment involves several steps. First, you need a diagnosis of mild cognitive impairment or mild Alzheimer’s dementia from a qualified physician. Next, you’ll need amyloid plaque confirmation through a PET scan or spinal fluid analysis. Your doctor then needs to be participating in, or willing to enroll in, a CMS-approved registry. Finally, the treating facility needs to be set up for regular infusion administration and MRI monitoring.
Not every neurology practice or memory clinic has the infrastructure for this yet. Larger academic medical centers and specialized Alzheimer’s treatment centers are more likely to have the registry participation and infusion capabilities already in place. If your current doctor doesn’t offer Leqembi, they can refer you to a center that does.