Presentation (CTI)

OBJECTIVES: Early detection of Alzheimer's Disease (AD) is vital for patient management, especially with the availability of new FDA-approved amyloid targeting therapies, which require testing to confirm amyloid pathology. Considering the autonomy of commercial health plans and separate review committees evaluating tests and therapies, our objective was to determine if health plans have concordant AD therapy and testing policies.
METHODS: Publicly available AD testing and therapy coverage policies were analyzed from 30 commercial health plans (covering 90% of the commercially insured US population). These policies were effective from 1/1/2024 through 12/31/2024 and included FDA-approved therapies (lecanemab and donanemab) and testing for amyloid pathology (cerebrospinal fluid [CSF] biomarker assays and amyloid positron emission tomography [PET] scans). Policies were categorized as covered, not covered, or silent (not publicly available). Concordance status was assessed by comparing the health plan’s testing method included in the drug policy for confirming amyloid pathology with their corresponding testing policies.
RESULTS: Out of 120 possible policies for both tests and therapies, 64% (n=77) were publicly available, while 36% (n=43) were silent. Among published policies, 55% (n=42) were categorized as covered: 26 drug policies (15 lecanemab, 11 donanemab) and 16 testing policies (8 CSF, 8 PET). Meanwhile, 47% (n=36) policies were categorized as not covered: 16 drug policies (9 lecanemab, 7 donanemab) and 20 testing policies (13 CSF, 6 PET). Out of 30 commercial health plans, 30% (n=9) had concordant covered policies; 17% (n=5) had discordant policies; 23% (n=7) had concordant noncovered policies; and 30% (n=9) silent (no publicly available policies for tests or therapies to compare).
CONCLUSIONS: Although there's often alignment between amyloid targeting therapies and testing policies, inconsistencies remain. As new technologies like plasma-based biomarkers become available, it’s essential for health plans to ensure policy concordance to minimize access variability for AD patients.