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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 New Mexico revised its Medicaid medical policy for amyloid-directed monoclonal antibodies (Leqembi and Kisunla) for Alzheimer's disease, effective 2026-12-01. Continuation-of-therapy criteria now require an Alzheimer's diagnosis and MRI monitoring for ARIA per FDA labeling, drop the earlier requirement for documented follow-up brain MRI, and add dosing-regimen criteria for intravenous Leqembi 10 mg/kg every two weeks. Leqembi IQLIK subcutaneous self-injection is handled under the pharmacy benefit unless the member's benefit plan says otherwise.
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What to do
Action · 3 steps
01By 2026-12-01: Billing team and providers should update prior authorization and continuation requests for Leqembi and Kisunla for New Mexico Medicaid members to reflect the revised criteria, including the Alzheimer's diagnosis, ARIA/MRI monitoring documentation, and the intravenous dosing-regimen attestation where the 10 mg/kg every-two-weeks regimen is requested.
02Front desk and infusion scheduling staff should confirm whether Leqembi IQLIK requests route to the pharmacy benefit rather than the medical benefit before scheduling.
03Claims for intravenous Leqembi without the required documentation attached to the authorization will be denied by the payer.
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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