Medicare and Leqembi

allit

Hi! Anyone out there on Leqembi and have Medicare? My wife is on Leqembi and just turned 65 and signed up for original Part A and B Medicare. We’re wondering how much Medicare pays for Leqembi? And how much is left over for the patient to pay? The first few infusions were given when she was still on my BCBS insurance. So we want to compare to see which coverage pays more so we can decide which one should be the primary coverage and which one the secondary.

Septamom

Good morning - are you aware of patient support programs that can help you decide what route would be better?
https://www.eisaipatientsupport.com/

harshedbuzz

When it was first approved, this was what was being reported.

Medicare says it will pay for the Alzheimer's medication Leqembi. Here's how it works. - CBS News

Her doctor's billing department might know.

MaryMN

My husband has traditional Medicare and a supplement. Between the two of them, his infusions have been no cost to us.

allit

I think we got it sorted out. My BCBS is the primary insurance now and they paid a big chunk. So far, unless we hear otherwise, Medicare picked up the rest. We’ll be crunching some numbers soon to see if it would be better to switch it around and have Medicare as primary. But for now we’re good.

South Dakota Dave

I was diagnosed with Alzheimer’s in April 2024 and decided to try Leqembi. Local Dr.’s failed us, so we decided to drive 635 miles to the Mayo Clinic in Rochester MN and stayed there a week. I and my wife found it the best thing we ever did. If we need help, our Mayo Dr’s will react quickly when needed.

I was one of about 14 Alzheimer’s patients at Mayo. The required infusions started on January 2024; this January 2025 I now have 27 infusions each following two weeks apart, each one is in a hospital and completed in about 2 ½ hours.

Recently, we heard of a new FDA approval scheduled for Leqembi that will be sometime after August 2025. I am much more hopeful now because we find Eisai (the owner) Leqembi has already been using their subcutaneous (SC) injector with Leqembi which gets us out of the infusion center every other week into a new at-home procedure to administer Leqembi much faster and significantly less costly and is showing the SC formulations resulted in 14% greater amyloid removal! I believe that has never been done.

It may be helpful to know that anyone that has Medicare, I’d suggest getting a good health supplement also. Reason: Medicare pays for Leqembi (great!) but the required infusions are not covered. In my state (South Dakota USA), the cost for that is about $1600 each month. BUT our supplement insurance covers it 100% with only a $190 cost each month.

We’ve learned a lot from the 27 infusions and would be glad to help with any questions or concerns about Leqembi.

We really need more Leqembi patients to demonstrate its capabilities!

Quilting brings calm

I hope you bought a Medicare supplement- such as Plan G. Otherwise you are going to have significant copays. Medicare B only pays for 80% of services

South Dakota Dave

I'm 73, I have Medicare with supplemental Plan F. My entire medical bill, including Leqembi from January 2024 to January 2025 each month is $190.00. That includes every local medical procedure, the $1600 Leqembi infusion each month and more MRI's than I can count (I have a very cautious neurologist), and the 5-day trip to Mayo Clinic which allows me to have Leqembi.

Also keep in mind that Leqembi is working on an at home autoinjector that takes 15 seconds to administer at home weekly rather than current infusion centers every other week at a significant saving and 14% greater amyloid removal!

JJ401

"My BCBS is the primary insurance now and they paid a big chunk. So far, unless we hear otherwise, Medicare picked up the rest. We’ll be crunching some numbers soon to see if it would be better to switch it around and have Medicare as primary…"

My understanding is that you can't choose which is primary. If you are covered by active work insurance that is primary. If you have retiree work insurance, Medicare is primary. So if you are still working and she is covered under your insurance, your insurance is primary.

South Dakota Dave

I have Medicare so we pay only $190 monthly on that (F) plan, it covers everything medical.

You have great primary insurance as I hear of folks that must pay the $26,500 Leqembi themselves and the infusion cost if not eligible for Medicare.