VHA Will Provide Coverage for Leqembi to Qualified Veterans with Early Alzheimer’s Disease

Eisai and Biogen announced that the Veterans’ Health Administration (VHA), part of the Department of Veterans Affairs (VA), is providing coverage of Leqembi to veterans living with early stages of Alzheimer’s disease. The VA has added the anti-amyloid-beta protofibril antibody, which secured accelerated FDA approval in January, to its list of nonformulary drugs.

The Veterans Health Administration (VHA) is America’s largest integrated health care system, providing care at 1,293 health care facilities, including 171 medical centers and 1,112 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.

It is estimated that by 2050, more than 13 million Americans of all ages will be living with Alzheimer’s disease (AD) or other forms of dementia, and the cost of care will swell to approximately $1.2 trillion.

The rapidly climbing number of those affected with dementia includes a growing population of Veterans, who may have an added risk for the disease as a consequence of traumatic brain injury, posttraumatic stress disorder, and other service-related injuries. Close to 168,000 veterans receiving care through the VA have Alzheimer’s dementia, according to government estimates.

Eisai is pricing the treatment at $26,500 per year in the U.S. Soleo Health, an innovative leader and national provider of complex specialty pharmacy services, was selected by Eisai as the sole specialty pharmacy distribution partner for Leqembi.

Soleo Health will distribute LEQEMBI to provider offices and infusion centers as well as administer it across its many Ambulatory Infusions Centers (AICs) nationwide, including those owned and operated through its provider division, Virtis Health.


Takeaway: The decision makes VA the first major insurer to agree to pay for the drug since its approval, while CMS continues to restrict its use