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Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of Kentucky revised its Medicaid medical benefit policy for Alzheimer's disease amyloid-directed monoclonal antibodies (Kisunla and Leqembi). Continuation-of-therapy criteria now require an Alzheimer's diagnosis and ARIA MRI monitoring per FDA labeling, drop the requirement for submitted follow-up MRI chart notes, and add new criteria for the intravenous Leqembi 10 mg/kg dosing regimens. Leqembi IQLIK subcutaneous self-injection is routed to the pharmacy benefit.
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What to do
Action · 4 steps
01By 2026-12-01: Billing team and providers should confirm that intravenous Leqembi and Kisunla requests for Kentucky Community Plan members include an Alzheimer's diagnosis, documented ARIA MRI monitoring per FDA labeling, and, for 10 mg/kg every-2-week requests, the required attestation or 18-month starting-phase justification.
02Update prior auth tracker and continuation request templates accordingly.
03Route Leqembi IQLIK subcutaneous requests for these members to pharmacy benefit workflows rather than the medical benefit, unless the member's benefit plan document states otherwise.
04Claims lacking the updated documentation may be denied.
Original notice
Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease
uhcprovider.com · Always check the source before changing claims.
Related changes
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