Medicare AdvantagePrior AuthMedium impact
Leqembi-Iqlik (lecanemab-irmb) subcutaneous auto-injector (Revised)
Humana·Neurology, Geriatrics, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Leqembi-Iqlik (lecanemab-irmb) subcutaneous auto-injector for Medicare Advantage plans, effective January 1, 2026. This medication treats mild cognitive impairment or mild dementia due to Alzheimer's disease and requires patients to have previously received 18 months of IV formulation treatment along with confirmed amyloid-beta pathology.
Action Required
Before January 1, 2026: Billing team must update prior authorization systems to include Leqembi-Iqlik subcutaneous auto-injector requirements for Medicare Advantage patients. Providers must verify patients meet all four criteria: documented MCI/mild AD diagnosis, appropriate disease staging (MMSE 22-30 or MoCA 17-30), confirmed amyloid-beta pathology via PET/CSF/blood test, and 18 months of prior IV formulation treatment. Visit www.humana.com/PAL for specific billing codes. Claims without proper prior authorization will be denied.