MAB2026063003

By July 6, 2026: (1) Billing team must update prior authorization workflows to require ALL prescriptions for Leqembi (lecanemab-irmb) and Kisunla (donanemab-azbt) to undergo prior authorization—no exceptions. (2) Providers must be notified that MAB requests now require submission of: cognitive assessment scores (MMSE ≥18 and ≤23 OR MoCA ≥18 and ≤25 OR CDR 0.5-1, with at least 2 of these three), baseline MRI results, biomarker confirmation (amyloid PET scan, cerebrospinal fluid testing, or FDA-cleared plasma biomarker assay), prescriber specialty verification (neurologist, psychiatrist, or geriatrician), and documentation of quarterly monitoring plans. (3) Update encounter forms and prior authorization templates to include checklist for all seven clinical criteria (FDA-approved indication, cognitive scores, appropriate dosing, dementia specialist, baseline MRI, biomarker confirmation, absence of contraindications). (4) Pharmacy and billing staff must flag any requests missing required documentation and route to physician reviewer rather than auto-denying, as clinical judgment exceptions are permitted. (5) Remove all references to Aduhelm (aducanumab) from prior authorization criteria and billing systems. Failure to obtain prior authorization before dispensing will result in claim denials; claims submitted without required clinical documentation will be pended for physician review.