Donanemab-azbt

Covers donanemab‑azbt (Kisunla) for initial and continued treatment of early Alzheimer disease (mild cognitive impairment due to AD or mild AD dementia) in patients ≥50 with objective baseline cognitive impairment and positive amyloid status (amyloid PET or CSF), a baseline brain MRI within one year, and baseline CDR‑GS 0.5–1 or MMSE 21–30, prescribed or consulted by a neurologist/neuropsychiatrist. Coverage is contingent on meeting all specified initiation/continuation criteria (including documented clinical benefit or stabilization and routine MRI monitoring for ARIA), prohibits concomitant use with other amyloid‑β antibodies, and is subject to member benefit plan, contract, and state regulatory limitations.

"Coverage of FDA‑approved drugs when prescribed for an off‑label use recognized as safe and effective in one or more standard medical reference compendia adopted by the U."