Alzheimer's – The New Treatment Landscape

Leqembi (lecanemab) and Kisunla (donanemab) are the first two FDA-approved treatments for Alzheimer’s disease. They target proteins that build up in the brain and are linked to Alzheimer’s, known as beta-amyloid plaques.¹

• Leqembi was approved in 2023 after showing modest improvementss in cognition and function

• Kisunla was approved in 2024 after trials showed that it could help slow Alzheimer’s by reducing beta amyloid build up in the brain.¹

Both drugs are given by IV infusion, mostly at out-patient facilities. This means that you will have to go to an infusion center to get these treatments; some doctors’ offices also offer these treatments. Leqembi is administered every two weeks and Kisunla is administered once per month.²

Both treatments have demonstrated in clinical trials that they may be able to help slow Alzheimer’s but neither drug can stop or reverse the disease.

Risks: Some patients may experience brain swelling or bleeding, especially those with two copies of the APOE4 gene. Doctors use brain scans and genetic tests to monitor safety.

It can take a while to start to receive these treatments. Here is an outline of what the typical process looks like:

1. Seek a diagnosis and assessment

To diagnose Alzheimer's disease, a specialist checks medical history, thinking skills, and brain function. This may include memory tests, physical exams, and blood tests. Doctors can look for amyloid plaques in the brain using a PET scan (a scan that shows doctors how your organs work) or spinal tap (a procedure to collect fluid from the spine for testing). A genetic test can show if a person has a higher risk of side effects like brain swelling or bleeding. Before treatment, an MRI is needed to check the brain for any risks.³

2. Determine If You Qualify

Leqembi and Kisunla are for people with early Alzheimer's symptoms (such as mild cognitive impairment, MCI ), like mild memory loss or confusion. To qualify, they must have amyloid plaques in their brain, confirmed by a scan or spinal fluid test. People with more severe dementia or other types of dementia cannot take it. People with two copies of the APOE4 gene, a certain brain condition called CAA (Cerebral amyloid angiopathy), or those taking certain blood thinners are at higher risk for more serious side effects, including brain swelling and bleeding.⁴

3. Beginning treatment

Leqembi and Kisunla are given through IV every two weeks, with each session lasting about an hour, at a designated infusion center. Many hospitals and healthcare providers do not yet offer these infusions . After the infusion, doctors will watch for side effects to make sure it's safe. Regular check-ups are needed to track progress and manage any side effects.⁵²

What’s the Timeline from Diagnosis to Treatment?

The time from diagnosis to starting Leqembi or Kisunla can vary. First, a doctor must confirm mild Alzheimer's or memory problems and test for beta-amyloid plaques. Then, the doctor must join a special Medicare registry and set up follow-up care. Once everything is in place, treatment can begin, but the process depends on testing, doctor coordination, and insurance approval.¹⁰

1. Medicare Coverage

Leqembi and Kisunla are covered by Medicare Part B, which pays 80% of the cost after the deductible (amount you pay out-of-pocket for covered healthcare services before your insurance plan starts paying anything) is met. Medicare also uses a special program called Coverage with Evidence Development (CED) to track how well these treatments work and if they are safe.

To get coverage, patients must have mild Alzheimer's or mild cognitive problems and show they have beta-amyloid plaques in their brain. The doctor must be part of a program that tracks treatment results, and the doctor must also have a qualified team to provide care.

Even though Medicare covers most of the cost, patients will still need to pay 20% of the cost after meeting their deductible.⁶

2. Paying Privately

If you are not using Medicare and using private insurance, you should check first to see if your insurance covers Leqembi and Kisunla.

Eisai, the manufacturer of Leqembi, has a patient support program and a copay assistance program that may help eligible patients afford the medication.⁷

Lilly, the manufacturer of Kisunla, has a patient assistance program called Lilly Cares Foundation Patient Assistance Program to help patients cover the costs.⁸

When talking to your doctor about Alzheimer's treatments, share your memory concerns. Give examples of memory changes or symptoms you’ve noticed. Also, ask about treatment options, including the benefits, risks, and who qualifies for them. A family member or caregiver can help support you in making the best decision for your care.⁹

To receive Leqembi or Kisunla, you’ll need to see a neurologist or memory care provider. They will check if you qualify and refer you to a clinic for IV infusions, usually at a hospital or infusion center. These drugs can’t be found at regular pharmacies. They need careful monitoring for side effects.⁹

To get more clarity on an Alzheimer’s diagnosis for yourself or a loved one, talk to your doctor. Consider asking about additional diagnosis options such as digital cognitive assessments and blood tests. It’s important to know that doctors can order blood tests from labs; however, these tests are for people who already have memory problems, not for individuals who just want to check their memory.⁹

The field of Alzheimer's treatment is changing quickly, with new medications and diagnostic tools becoming available every year. Stay informed about the latest options that can help you and your doctor make the best decisions for your care. Keep asking questions, exploring new options, and working with your healthcare team to find the right approach for your needs.