Payer PolicyActive
Kisunla® (donanemab-azbt) Medicare Advantage
EVICORE-MEDICAL_DRUG-6546D43B
EviCore by Evernorth
Effective: July 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Kisunla (donanemab‑azbt) is covered only for Alzheimer's disease initiated in patients with mild cognitive impairment or mild dementia and is limited to those with confirmed amyloid‑beta pathology who are enrolled in a CMS‑approved prospective comparative study or an NIH‑supported clinical trial. Approval is for 12 months, requires documentation of diagnosis, amyloid confirmation, study participation and applicable safety criteria, and dosing must follow the IV schedule (700 mg IV ~30 minutes every 4 weeks for the first 3 doses, then 1400 mg IV every 4 weeks).
Coverage Criteria Preview
Key requirements from the full policy
"Kisunla is indicated for the treatment of Alzheimer's disease."
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