lecanemab-irmb

Generic: Leqembi

200 MG, 360 MG, 500 MG — Auto-Injector

Also known as: LEQEMBI IQLIK

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

3 plans

Source: CMS QHP JSON · Formulary date: May 13, 2026 · Checked: 16 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas VIP Care (HMO D-SNP) via Leqembi	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO) via Leqembi	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Leqembi	Tier 5 - Specialty	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Leqembi	Non-Preferred	✓	—	—	PA

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Leqembi	Medical Benefit	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Leqembi	Medical Benefit	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Leqembi	Medical Benefit	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: May 29, 2026 · Checked: 16 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA