If you or someone you love has been diagnosed with early Alzheimer’s disease, you’re facing this challenge during a remarkable time in medical history. The treatment landscape has shifted dramatically, with the first disease-modifying therapies now available and Medicare coverage expanding to make them more accessible. Keep reading to discover your options for both treatment and financial assistance, as you plan for what comes next in your care journey.
New Disease-Modifying Therapies
For decades, Alzheimer’s treatment focused solely on managing symptoms rather than addressing the underlying disease. That’s changed with the FDA approval of two groundbreaking monoclonal antibodies: lecanemab (Leqembi) and donanemab (Kisunla). These medications represent the first treatments that actually slow the progression of cognitive decline by targeting and clearing amyloid plaques from your brain.
Lecanemab received full FDA approval in July 2023 after clinical trials showed it slowed disease progression by 27% over 18 months. The medication works by targeting soluble amyloid protofibrils, which researchers believe are more toxic than the insoluble plaques themselves. You’ll receive lecanemab as an intravenous infusion every two weeks during the initial 18-month treatment period at a clinical or infusion center.
Donanemab, approved in July 2024, takes a different approach by targeting a modified form of beta-amyloid found only in established brain plaques. Clinical trials demonstrated a 35% slowing of disease progression, making it slightly more effective in some measures. What makes donanemab unique is its “treat-to-target” model, meaning you can stop infusions once PET scans confirm your amyloid plaques have been cleared to minimal levels. This approach potentially reduces your long-term drug exposure and overall healthcare costs.
A significant advancement came in August 2025 when the FDA approved Leqembi Iqlik, a subcutaneous autoinjector for maintenance dosing. If you’ve completed the initial 18 months of IV therapy, you can now transition to a once-weekly self-administered injection at home. This development is particularly valuable if you live in a rural area or have limited access to infusion centers, as it dramatically reduces the burden of frequent hospital visits.
Understanding ARIA Safety Risks
Before starting either lecanemab or donanemab, you need to understand the primary safety concern associated with these treatments: amyloid-related imaging abnormalities, commonly called ARIA. This condition occurs when the removal of amyloid from the walls of cerebral blood vessels increases vascular permeability, potentially causing brain edema (ARIA-E) or microhemorrhages (ARIA-H).
Clinical trial data show that about 21% of patients experienced some form of ARIA, with most cases being mild or asymptomatic and detected only through routine MRI monitoring. A smaller percentage of patients develop symptoms such as headache, confusion, dizziness, or visual changes. Because risk is higher in individuals who carry two copies of the ApoE ε4 gene, genetic testing is often recommended before beginning treatment.
Current prescribing guidelines require a baseline brain MRI before treatment begins, followed by additional MRIs before the 3rd, 5th, 7th, and 14th infusions, and whenever symptoms suggest possible ARIA. If symptomatic ARIA occurs, treatment is typically paused until imaging confirms the condition has resolved.
Medicare Part B Covers Infusions
Because lecanemab and donanemab are administered by a physician through intravenous infusion, they’re covered under Medicare Part B. This is significant because Part B covers outpatient medical services and physician-administered drugs, making these expensive treatments accessible to Medicare beneficiaries who meet specific criteria.
To qualify for Medicare Part B coverage, you must have a documented diagnosis of mild cognitive impairment or mild dementia due to Alzheimer’s disease, along with confirmed amyloid pathology established through amyloid PET imaging or cerebrospinal fluid analysis. Coverage applies when your prescribing clinician determines you meet CMS criteria and submits required clinical data through a CMS-approved qualifying study or registry, which allows Medicare to monitor real-world safety and outcomes.
Under standard Part B coverage, you’re typically responsible for 20% coinsurance after meeting your annual deductible. For 2026, the Part B monthly premium is $202.90, and the annual deductible is $283. Given that these medications cost approximately $26,500 annually, your 20% coinsurance could amount to roughly $5,300 to $5,500 per year. If you have a Medigap supplemental insurance policy, it will likely cover most or all of this coinsurance, substantially reducing your out-of-pocket costs.
Medicare Advantage plans are also required to cover these treatments, though their cost-sharing structures vary. In 2026, Medicare Advantage out-of-pocket maximums can reach up to $9,250 for in-network services. If you’re enrolled in TRICARE for Life, Medicare remains the primary payer for these infusion treatments, with TRICARE typically covering eligible remaining costs as secondary insurance. Coverage coordination and authorization requirements can vary, so confirming benefits with both programs before starting treatment is important.
Medicare Part D for Home Injections
The approval of subcutaneous Leqembi Iqlik creates an important shift in how you might pay for your Alzheimer’s treatment. Because this formulation is self-administered at home rather than given by a healthcare provider, it’s covered under Medicare Part D as a pharmacy benefit rather than under Part B.
This transition to Part D coverage could actually work to your financial advantage thanks to provisions in the Inflation Reduction Act. In 2026, your total out-of-pocket spending on Part D prescription drugs is capped at $2,100 per year. This means that if you transition from IV lecanemab to the subcutaneous maintenance version, your annual costs could drop from approximately $5,300-$5,500 under Part B to just $2,100 under Part D. For beneficiaries without supplemental insurance, this represents substantial savings.
When evaluating your options, consider reviewing your Part D plan during the Medicare Open Enrollment period, which runs from October 15 through December 7 each year. Different Part D plans may have varying formulary placements and cost-sharing arrangements for Leqembi Iqlik, with maximum deductibles reaching up to $615 in 2026. Taking time to compare plans ensures you’re getting the most favorable coverage for your specific medication needs.
Blood Tests Simplify Diagnosis
Confirming amyloid pathology in your brain has traditionally required either an expensive PET scan or an invasive lumbar puncture for cerebrospinal fluid analysis. These barriers have limited access to diagnosis and treatment for many patients. However, 2025 brought a revolution in diagnostic testing that could dramatically simplify your path to treatment.
The FDA approved the first blood-based Alzheimer’s test in May 2025. Known as Lumipulse, this test measures p-tau217 and amyloid-beta 1-42 in blood plasma and helps predict amyloid PET scan results. In October 2025, the FDA cleared the Elecsys pTau181 test for use in primary care settings to help rule out amyloid pathology in symptomatic adults aged 55 and older.
The Alzheimer’s Association’s 2025 Clinical Practice Guidelines now suggest that high-sensitivity blood-based biomarkers can serve as confirmatory tests in specialized memory care settings, potentially reducing reliance on PET and CSF analysis for many patients. This shift is expected to dramatically reduce the time between when you first notice symptoms and when you can begin treatment. If you’re experiencing memory concerns, these new blood tests available through your primary care physician could be your first step toward understanding what’s happening and accessing appropriate treatment.
It’s important to note that these blood tests are not intended to be used as stand-alone diagnostic tools. Results must be interpreted alongside clinical evaluation, cognitive testing, and, when appropriate, imaging or cerebrospinal fluid analysis before treatment decisions are made.
Conclusion
The Alzheimer’s treatment landscape has fundamentally transformed with the approval of disease-modifying therapies that offer the first real hope for slowing cognitive decline. Between lecanemab and donanemab for active treatment, the new subcutaneous maintenance option, expanded Medicare coverage pathways, and revolutionary blood-based diagnostics, you have more options than ever before. Understanding how Medicare Part B covers physician-administered infusions and how Part D’s $2,100 out-of-pocket cap applies to self-administered medications can significantly impact your treatment planning and financial preparation.
While these therapies aren’t cures, they represent a meaningful step toward converting Alzheimer’s from a rapidly progressive condition into a more manageable chronic illness. The combination of clinical advances and supportive federal reimbursement policies means that effective treatment is increasingly within reach if you’re diagnosed at early stages. Seek help promptly, as current disease-modifying therapies are only approved for Alzheimer’s disease at the mild cognitive impairment or mild dementia stage. For more information about Alzheimer’s treatments and Medicare coverage, please call 866-633-4427 to speak with a Senior Healthcare Solutions Medicare expert.
