By MOAA Staff

A first-of-its-kind drug treating early stage Alzheimer’s disease via in-home injection has been added to the TRICARE formulary.

Patients who receive the monoclonal antibody Leqembi via intravenous infusion every two weeks for 18 months now may continue treatment with similar infusions every four weeks or a weekly subcutaneous at-home injection. The Leqembi Iqlik (pronounced “I-Click”) auto-injector is appearing in the TRICARE formulary as a Tier 3 drug with a 30-day supply available for a $76 copay.

Providing coverage for the at-home maintenance option will allow beneficiaries to avoid travel to infusion centers for follow-up care.

Beneficiaries must have prior authorization and submit a medical necessity form to verify coverage. The injector may be found at a retail pharmacy or a military treatment facility, but beneficiaries likely will need to obtain the Leqembi Iqlik via Accredo, which provides specialty pharmacy services to TRICARE beneficiaries.

Coverage of the at-home treatment comes after the Food and Drug Administration approved the at-home maintenance dosing in August and after drugmaker Biogen introduced Leqembi Iqlik in the U.S. in early October. About a year earlier, MOAA and other advocacy groups successfully led an effort to secure TRICARE coverage for monoclonal antibodies Leqembi and Kisunla, closing a coverage gap faced by early Alzheimer’s sufferers for more than a year. 

[MEMBER-EXCLUSIVE MOAA PUBLICATION: Transitioning Into Medicare and TRICARE For Life] 

TRICARE’s coverage of monoclonal antibodies is provisional, and may last up to five years.

MOAA will continue monitoring drug coverage changes as part of its overarching work to ensure a world-class health benefit for those who serve and have served, with care on par with Medicare, federal employee plans, and other benchmarks. 

TRICARE beneficiaries with questions about the pharmacy program or their prescriptions should consult with their provider, visit TRICARE.mil for program details and forms, or reach out to Express Scripts at (877) 363-1303.