Leqembi

(lecanemab-irmb)
LEQEMBI 200 MG in 2 ML InjectionLEQEMBI 500 MG in 5 ML Injection

Dosage & administration

drug label

Leqembi prescribing information

prior authorization

Leqembi prior authorization resources

Most recent Leqembi prior authorization forms

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Verified: Sep 26, 2023Blue Cross Blue Shield of Michigan - Leqembi Prior Authorization Form (Medical Benefit)
Verified: Sep 21, 2023Aetna - Leqembi Prior Authorization Form

PDF
Complete Letter of Medical Necessity

PDF
Coverage Authorization Request

PDF
Coverage Authorization Appeals

PDF
Request for Prescription Drug Coverage Exception Letter
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Benefits investigation

PDF
Leqembi Eisai Patient Support Program Enrollment Form
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pharmacy

Leqembi preferred pharmacy

PDF
Pharmacy List

financial assistance

Leqembi financial assistance options

Co-pay savings program

commercial only

PDF
Leqembi Eisai Patient Support Program Enrollment Form
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Bridge program

commercial only

PDF
Leqembi Eisai Patient Support Program Enrollment Form
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Foundation programs

under insured
no insurance
goverment insurance
65+

PDF
Leqembi Eisai Patient Support Program Enrollment Form
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patient education

Leqembi patient education

Getting started on Leqembi

To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

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Other resources

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people also ask

Leqembi FAQs

How is the dosage of Leqembi?Leqembi is available in 2 dosages, including 100 mg/ml Injection 2 ml and 500 mg/5ml Injection 5 ml
What does Leqembi treat?Leqembi treats Alzheimer Disease
How Is Leqembi Administered?Leqembi is administered as a Injectable
FAQ Data Source