Leqembi_Alzheimers_Criteria
Defines prior authorization, clinical eligibility, dosing/monitoring and reauthorization criteria for Leqembi (lecanemab-irmb) under the pharmacy and medical benefits for Mass General Brigham Health Plan / MassHealth UPPL members, effective 2025-06-01. Applies to new members continuing therapy when continuation criteria are met and specifies MRI and cognitive testing requirements and approval durations.
05/15/25 Reviewed and updated for P&T; formatting and references updated; Aduhelm removed due to removal from the market; Adlarity removed from document and guidance to pharmacy benefit provided; reauthorization criteria split based on first and subsequent requests.
Leqembi included in criteria (09/13/2023) with provider specialty clarification, SLUMS added, MRI timeline changed from 3 to 12 months, and Leqembi preferred trial.
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