Some private insurers are balking at paying for Leqembi, the first drug fully approved to slow mental decline in Alzheimer's patients, because they still see the $26,000-a-year drug as experimental.
in which the drug slowed memory and thinking decline by about five months in those who got the treatment compared with those who got a dummy drug. Some Alzheimer’s experts say the delay is likely too subtle for patients or their families to notice.
Highmark and the North Carolina plan say they are still monitoring Leqembi and could re-evaluate their decision. Prominent insurers that will cover the drug for commercial plans include Kaiser Permanente and Elevance Health, the largest provider of Blue Cross-Blue Shield plans in the United States. A spokesman for another big health insurer, UnitedHealthcare, declined to comment when contacted by AP.
Chambers said they have found that the decision to not cover a drug largely happens when the evidence supporting the drug is considered questionable.
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