Leqembi® (Lecanemab-Irmb) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers intravenous Leqembi only for early symptomatic Alzheimer’s disease (MCI due to AD or mild AD dementia) and excludes use for other indications, concurrent use with other anti‑amyloid monoclonal antibodies, and patients with intracerebral hemorrhage within the prior year. Coverage requires documented amyloid pathology (positive amyloid PET or CSF), a baseline brain MRI within 12 months and specified cognitive scores (MMSE 20–30 or MoCA 17–30 or SLUMS 17–30), treatment by a qualifying dementia specialist, counseling and prescriber attestations on ARIA, ApoE ε4 and anticoagulant risks, adherence to FDA dosing, detailed medical-record documentation, initial authorization ≤6 months and reauthorization ≤12 months with required follow‑up MRIs and ARIA management.

"Intravenous administration of Leqembi (lecanemab-irmb) by a healthcare professional for the treatment of Alzheimer's disease when all applicable criteria below are met."