Response to Lecanemab (Leqembi®)
Posted on: Monday, July 10th, 2023
The Glenn Biggs Institute for Alzheimer’s and Neurodegnerative Diseases is excited about the progress of promising new therapies for Alzheimer’s disease, including lecanemab.
We acknowledge this is a first step in treatment advancements, and although the medicine is demonstrating a modest benefit, there is the possibility of side-effects like brain swelling.
Lecanemab is not for everyone and is only suitable for persons with mild dementia and at low risk for complications like bleeding.
Currently, Medicare, the Veteran’s Administration and other insurance providers have not decided on definitive guidelines for who qualifies for treatment and how much Medicare or other insurance providers will cover the cost of the medication.
We are actively working with the drug manufacturer, Eisai and Biogen, and with UT Health San Antonio’s infusion centers to put these procedures in place.
Currently, the cost of lecanemab is estimated at $60,000 per year.
In addition to the drug cost and to qualify for lecanemab, patients can expect expenses estimated at $5,000 to $10,000 for preliminary workups and infusions administered every two weeks.
The preliminary workup consists of:
- MRI brain scan.
- Genetic testing for APOE.
- Confirmation of amyloid accumulation in the brain either by a lumbar puncture with an estimated cost of $1,500 (often covered by insurance) or an out-of-pocket expense of an amyloid PET brain scan at an estimated additional cost of $11,000.
Reimbursement guidelines are being worked out among Medicare and other insurance providers. We expect more information on these details in the coming weeks.
Medicare estimates potential coverage at 80% covered and 20% patient out-of-pocket (roughly $10,000 annually). Medicare sets guidelines for all other insurance coverage.
After insurance is verified, patients will need to schedule a screening appointment to learn if they qualify, followed by monthly appointments with our clinical team to review possible side effects.
Current patients of the institute that qualify for lecanemab can expect more information from our clinical research team within the next few months as Medicare guidelines are finalized.