Insurers selling coverage in North Carolina, Pennsylvania and New York, among other states, said they won’t cover Leqembi with insurance offered on the individual market and through employers because they still see the $26,000-a-year drug as experimental.
FILE - This image provided by Eisai in January 2023 shows vials and packaging for their medication, Leqembi. Several health plans in the U.S. will not cover the recently approved Alzheimer’s drug for certain customers, exposing those patients to thousands of dollars in potential costs. Their decision stands in contrast to Medicare.
But people under 65 — even, rarely, as young as their 30s — also can get diagnosed. They are more likely to have commercial coverage. “That re-evaluation made it clear to us that the existing evidence does not allow for conclusions to be drawn about the safety and effectiveness of Leqembi,” said Dr. Heidi Syropoulos, a medical director with the insurer.
For commercial coverage, insurers often pay for treatments that have full FDA approval. But that is not guaranteed.
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