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Monoclonal Antibodies for Treatment of Alzheimer’s Disease

Blue Cross & Blue Shield of Mississippi·MS · Neurology, Geriatrics, Family Medicine +1 more·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

BCBSMS policy declares Kisunla (donanemab-azbt) and Leqembi (lecanemab-irmb) monoclonal antibodies for Alzheimer's disease as not medically necessary, citing availability of other covered treatment options. Services related to delivery/administration of these medications without BCBSMS prior authorization approval will also be considered not medically necessary.

Action Required

Action needed
Immediately: Billing team must verify BCBSMS prior authorization approval before billing HCPCS codes J0174 (lecanemab-irmb) and J0175 (donanemab-azbt). Update billing system to flag these codes for PA verification. Inform providers that claims for these Alzheimer's medications will be denied without proper authorization as they are considered not medically necessary by BCBSMS.

Affected Billing Codes

J0174
J0175

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