Kisunla™ (Donanemab-Azbt) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Kisunla (donanemab‑azbt) only for Alzheimer's disease (MCI due to AD or mild AD dementia) and excludes use for other indications or in combination with other Aβ monoclonal antibodies. Coverage requires documented positive amyloid PET, baseline and follow‑up MRIs with ARIA monitoring, cognitive scores in specified ranges (MMSE 20–30, MoCA 17–30, or SLUMS 17–30), no intracerebral hemorrhage in the past year, prescriber specialty (neurologist/geriatric psychiatrist/geriatrician), counseling/offers for ARIA and ApoE ε4 testing (and anticoagulant counseling if applicable), adherence to FDA dosing, required medical record documentation, initial authorization ≤6 months and reauthorization ≤12 months with specific PET timing for continuation.

"Kisunla (donanemab-azbt) is proven for the treatment of Alzheimer's disease (AD) when all of the following criteria are met: For initial therapy: Diagnosis of one of the following based on National..."