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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 Tennessee revised its Medicaid medical benefit policy for Alzheimer's amyloid-directed monoclonal antibodies (Leqembi and Kisunla), effective 2026-12-01. Continuation-of-therapy criteria now require an Alzheimer's diagnosis and MRI ARIA monitoring per FDA labeling, and the prior removed the requirement for chart notes confirming follow-up MRI; a new Leqembi intravenous dosing criterion was added, and Leqembi IQLIK self-administered subcutaneous injection is routed to the pharmacy benefit unless the member's plan document says otherwise.
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What to do
Action · 2 steps
01By 2026-12-01: Billing team and providers should update prior authorization submissions for continuing Leqembi or Kisunla infusions so requests document the Alzheimer's diagnosis, follow-up MRI for ARIA monitoring, and, where applicable, the ARIA severity attestation and the requested Leqembi intravenous dosing regimen (10 mg/kg every 2 weeks or every 4 weeks) with the required rationale.
02Front desk and intake staff should confirm whether each Leqembi IQLIK patient is being handled under the pharmacy benefit rather than the medical benefit, and route those prescriptions accordingly in the prior auth tracker and charge entry.
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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