Medicare will pay for Alzheimer's drug Leqembi. What patients and doctors should know

Medicare's decision to cover Leqembi, which came moments after the Food and Drug Administration fully approved the drug Thursday, promises to make the treatment moreMedicare coverage is crucial for most patients to have any hope of being able to afford Leqembi. Eisai has priced Leqembi at $26,500 per year before insurance coverage, which is extraordinarily expensive for Medicare patients, who have a median income of about $30,000.

People with Medicare Advantage plans also typically pay 20% for drugs such as Leqembi, up to their out-of-pocket maximum, which was about $5,000 on average for in-network services, according to KFF.People of modest means might not be able to afford the out-of-pocket costs for Leqembi even with Medicare coverage, said Tricia Neuman, an expert on Medicare at KFF.

To get diagnosed with Alzheimer's or a mild cognitive impairment, patients must undergo a cognitive evaluation and have a PET scan or spinal tap to detect the amyloid protein associated with the disease. PET scans are the most common method to detect amyloid because they are less invasive. The federal Centers for Medicare and Medicaid Services has set up a nationwide portal that is supposed to make it easy for doctors to enter the required information about their patients. CMS has released a video that shows doctors how to navigate the system:Dr. David Knopman, a neurologist who specializes in Alzheimer's disease at the Mayo Clinic in Minnesota, said the registry is minimalist and unlikely to be burdensome to patients and physicians.

People with two copies of a gene mutation called APOE4 are at higher risk of swelling and bleeding and patients should be tested to confirm whether they have the mutation before taking Leqembi, according to the FDA. Medicare covers testing for the APOE4 mutation, a CMS spokesperson said.

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