Lecanemab-irmb

Covers Lecanemab‑irmb (Leqembi®) for treatment of Alzheimer disease when all policy criteria are met, including documented amyloid pathology (PET or CSF), a baseline brain MRI, and baseline cognitive staging (CDR global 0.5–1 or MMSE 22–30). Coverage is limited to HCSC members (Ohio) aged ≥50 with mild cognitive impairment due to AD or mild AD dementia, requires prior authorization and adherence to compendia/literature evidence standards, and excludes use for patients <50, non‑AD indications, non‑formulary or investigational uses and other plan‑specified limitations.

"Requested therapy must be proven effective for the relevant diagnosis or procedure."

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