Payer PolicyActive
Leqembi™ (lecanemab-irmb)
EVICORE-MEDICAL_DRUG-8E0540C2
EviCore by Evernorth
Effective: May 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Leqembi (lecanemab-irmb) is not recommended for approval/coverage by this policy due to insufficient evidence of clinically meaningful benefit and demonstrated safety concerns, so coverage is effectively excluded pending additional clinical trials. If requested, treatment would be limited to the FDA-indicated population (Alzheimer’s disease with mild cognitive impairment or mild dementia) and must meet applicable coverage guidelines and safety criteria, with no additional documentation requirements specified.
Coverage Criteria Preview
Key requirements from the full policy
"When requesting Leqembi (lecanemab-irmb), the individual requiring treatment must be diagnosed with the following FDA-approved indication and meet the specific coverage guidelines and applicable sa..."
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