Abstract

Since 2023, disease-modifying anti-amyloid therapies have become clinically available for early-stage Alzheimer’s disease (AD), and blood-based biomarkers have accelerated diagnostic precision. In parallel, the Centers for Medicare & Medicaid Services (CMS) expanded coverage for PET imaging and restructured Medicare Part D for 2025, reshaping affordability and cash-flow considerations for affected families. This article reviews key post-2022 developments in AD diagnostics, treatment access, and coverage policy, and introduces a financial planning framework—integrating care navigation, budgeting, and estate and benefits coordination—to support advisors working with clients impacted by AD.

Keywords

Alzheimer’s disease; lecanemab; donanemab; blood biomarkers; amyloid PET; Medicare Part D redesign; care planning; estate planning.

Introduction and Burden

Alzheimer’s disease remains one of the costliest and most disruptive conditions for U.S. families. The 2026 Alzheimer’s Disease Facts & Figures report estimates there are 7.4 million people age 65⁺ living with AD and projects $409 billion in 2026 costs for health care, long-term care, and hospice, alongside rising caregiver stress, and loss of caregiver income[i]. Recent regulatory and diagnostic advances require a refresh of financial and estate planning assumptions.

Diagnostics (2023–2026)

Blood‑based biomarkers. Blood based biomarkers include two hallmark proteins associated with AD: beta-amyloid (Aβ) and tau. National laboratories now offer plasma p‑tau217 testing[ii], and in May 2025 the first FDA‑cleared blood‑based IVD (Fujirebio’s Lumipulse pTau‑217/Aβ42 ratio) became available, and is now offered nationally through Labcorp[iii], creating a lower‑friction path to confirm amyloid pathology and triage patients for imaging and therapy. In July 2025, the Alzheimer’s’ Association released its first clinical practice guideline for the use of blood-based biomarker test in the diagnosis, treatment, and care of people with AD[iv]. By August 2026, the FDA had cleared four blood tests, including the first single biomarker pTau217 test cleared to both rule in and rule out amyloid pathology in primary as well as specialty care settings[v]. Moving the first diagnostic step into the primary care office may shorten the path to diagnosis and reduce early reliance on costly specialist visits and PET imaging.

Amyloid PET access. Prior to October 2023, CMS initially required Coverage with Evidence Development (CED), covering one PET scan per lifetime, while gathering evidence. CMS removed this national CED restriction for β‑amyloid PET scans in Oct 2023, shifting coverage decisions to local Medicare Administrative Contractors —facilitating eligibility confirmation, multiple PET scans, and treatment monitoring[vi].

Therapies and Coverage

Donanemab and lecanemab are two medications approved for people with early-stage Alzheimer’s disease, specifically those who have confirmed amyloid buildup in the brain.

Leqembi® (lecanemab). Leqembi® converted to traditional FDA approval (July 6, 2023) on the condition of enrolling patients in a minimal data registry. More importantly, CMS covers prescribers using a minimal data collection approach—requiring just enough core data to monitor outcomes, rather than extensive clinical details, thus enabling Medicare to provide early access to promising treatments[vii].

Kisunla™ (donanemab). FDA approval (July 2, 2024) for early symptomatic AD; allowing for monthly infusions with evidence supporting stopping therapy when amyloid is cleared[viii]. This is covered by Medicare under the same registry framework mentioned above[ix].

Leqembi Iqlik® (subcutaneous lecanemab). In August 2025, the FDA approved a weekly at-home autoinjector for maintenance dosing of lecanemab, and on July 13, 2026, extended that approval to treatment initiation, so patients can now begin and continue therapy without regular infusion-center visits[x]. Self-administration may reduce travel, caregiver time, and facility costs, and because a self-injected drug is typically dispensed through the pharmacy benefit, some drug spending may shift from Part B coinsurance toward the Part D out-of-pocket cap. Families should confirm coverage with their specific plan. Baseline and periodic MRI monitoring are still required.

Monitoring & risk.

Both drugs come with a warning about a possible side effect called amyloid-related imaging abnormalities, which can affect the brain and needs to be monitored using regular magnetic resonance imaging (MRI) scans[xi].

Because of this, anyone considering these treatments should also plan for the timing and cost of MRIs and PET scans, as these can impact overall healthcare expenses. If you are building a financial or care plan, it is important to include these imaging costs in your cash flow projections.

Costs and Benefit Design

Drug pricing. Public list prices are approximately $26,500/year for Leqembi[xii] and $695.65 per vial for Kisunla (≈ $32,000 for 12 months; total varies by time to plaque clearance)[xiii].

Part D redesign (2025). Part D reforms are particularly impactful for individuals managing chronic conditions such as Alzheimer’s disease, where symptomatic medications and polypharmacy are common. The ability to predict and manage drug-related expenses more effectively supports both clinical care and financial planning.

The most notable changes are a $2,100 annual out-of-pocket cap in 2026 (up from $2,000 in 2025) for prescription drug costs, offering financial relief to beneficiaries with high medication expenses; elimination of the coverage gap (commonly known as the “donut hole”), simplifying the benefit structure and reducing cost variability; and, monthly payment smoothing, allowing beneficiaries to spread their drug costs evenly throughout the year rather than facing large, unpredictable bills. However, Medicare Part B coinsurance remains in effect for office-administered services, including diagnostic imaging such as PET scans and MRIs. These procedures are often required for monitoring disease progression and treatment response, especially in patients receiving anti-amyloid therapies[xiv].

Planning Implications

Care‑pathway budgeting. The typical care pathway for Alzheimer’s diagnosis and treatment includes several steps: starting with a cognitive screening, followed by a blood test to detect Aβ and tau biomarkers, and then confirmatory imaging like PET or MRI scans. If results support a diagnosis, patients may discuss eligibility for treatment and enroll in an infusion program with ongoing safety monitoring.

Each step involves both direct and indirect costs, which can vary depending on whether the patient has Medigap or Medicare Advantage coverage. Financial planning should account for these costs, including imaging and treatment timing, to avoid unexpected expenses and ensure access to care[xv].

Risk management & housing. As part of Alzheimer’s care planning, it is important to evaluate long-term care insurance options before a diagnosis is made, as coverage may be limited afterward. Families should also consider home modifications—such as safety upgrades and support services—to allow aging in place. If additional funding is needed, tapping into retirement plans and home equity through a reverse mortgage may be an option. Federally insured Home Equity Conversion Mortgages (HECMs) are available to homeowners aged 62 and older, while some private products may be accessible starting at age 55.

Estate and digital readiness. While some legal documents can be completed without an attorney, consulting a lawyer who specializes in elder law is highly recommended. They can provide guidance on health care decisions, property management, and coverage options through Medicare, Medicaid, veterans benefits, and long-term care insurance. Have the attorney execute or refresh durable POA, health care POA, living will and consider revocable trusts. Consider using remote notarization where available to simplify execution[xvi].

To protect assets and loved ones from rising financial exploitation risks, individuals should consider adding digital asset directives under the Revised Uniform Fiduciary Access to Digital Assets Act (RUFADAA), which allows trusted individuals to manage online accounts if the account holder becomes incapacitated or passes away[xvii]. Financial institutions also offer safeguards such as trusted contacts and transaction holds to help prevent unauthorized activity. According to the Financial Crimes Enforcement Network (FinCEN), elder financial exploitation is a growing concern[xviii], making these tools essential components of a modern financial plan.

Conclusion

Recent advances in Alzheimer’s diagnostics and treatments such as blood-based biomarkers, expanded imaging access, and FDA-approved therapies—require a fresh approach to financial and estate planning. With Medicare reforms capping drug costs and simplifying benefit structures, families can better anticipate expenses. However, imaging and infusion-related costs still demand careful budgeting. Advisors should integrate these clinical developments into financial models, while also addressing long-term care, housing, legal safeguards, and digital protections to ensure comprehensive, adaptive planning

[i] Alzheimer’s Association. (2026). 2026 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 22, e71345. https://doi.org/10.1002/alz.71345

[ii] Quest Diagnostics. (2024, April 22). Quest Diagnostics adds p‑tau217 blood biomarker testing to suite of services designed to assess risk and help aid diagnosis of Alzheimer’s disease [Press release]. Retrieved from https://newsroom.questdiagnostics.com/2024-04-22-Quest-Diagnostics-Adds-p-tau217-Blood-Biomarker-Testing-to-Suite-of-Services-Designed-to-Assess-Risk-and-Help-Aid-Diagnosis-of-Alzheimers-DiseasLe

[iii] Labcorp. (2025, August 18). Labcorp launches first FDA‑cleared blood test for Alzheimer’s disease [Press release]. Retrieved from https://ir.labcorp.com/news-releases/news-release-details/labcorp-launches-first-fda-cleared-blood-test-alzheimers-disease

[iv] Palmqvist, S., Whitson, H. E., Allen, L. A., Suarez‑Calvet, M., Galasko, D., Karikari, T. K., Okrahvi, H. R., Paczynski, M., Schindler, S. E., Teunissen, C. E., Zetterberg, H., Carrillo, M. C., Edelmayer, R. M., Mahinrad, S., McAteer, M. B., Kahale, L. A., Pahlke, S., Tampi, M. P. (2025). Alzheimer’s Association clinical practice guideline on the use of blood-based biomarkers in the diagnostic workup of suspected Alzheimer’s disease within specialized care settings. Alzheimer’s & Dementia, 21(7), e70535. https://doi.org/10.1002/alz.70535

[v] Roche Diagnostics. (2026, August 24). Roche receives FDA clearance for Elecsys® pTau217, advancing Alzheimer’s disease assessment across primary and specialty care [Press release]. Retrieved from https://diagnostics.roche.com/us/en/news-listing/2026/fda-elecsys-ptau217-alzheimers-blood-test.html

[vi] Centers for Medicare & Medicaid Services. (2024, April 1). Final CY 2025 Part D Redesign Program Instructions Fact Sheet [Fact sheet]. Retrieved from https://www.cms.gov/newsroom/fact-sheets/final-cy-2025-part-d-redesign-program-instructions-fact-sheet

[vii] U.S. Food & Drug Administration. FDA Converts Novel Alzheimer’s Disease Treatment to Traditional Approval (Leqembi). July 6, 2023.

[viii] U.S. Food & Drug Administration. FDA Approves Treatment for Adults with Alzheimer’s Disease (Kisunla/donanemab). July 2, 2024

[ix] U.S. Food & Drug Administration. FDA Converts Novel Alzheimer’s Disease Treatment to Traditional Approval (Leqembi). July 6, 2023

[x] Eisai Inc. (2026, July 13). FDA approves LEQEMBI IQLIK® (lecanemab-irmb) subcutaneous injection as an initiation dose for early Alzheimer’s disease [Press release]. Retrieved from https://media-us.eisai.com/2026-07-13-FDA-Approves-LEQEMBI-IQLIK-R-lecanemab-irmb-Subcutaneous-Injection-as-an-Initiation-Dose-for-Early-Alzheimers-Disease

[xi] U.S. Food & Drug Administration. FDA Converts Novel Alzheimer’s Disease Treatment to Traditional Approval (Leqembi). July 6, 2023. U.S. Food & Drug Administration. FDA Approves Treatment for Adults with Alzheimer’s Disease (Kisunla/donanemab). July 2, 2024

[xii] BioPharma Dive. Leqembi List Price: $26,500/yr. January 6, 2023.
https://www.biopharmadive.com

[xiii] Managed Healthcare Executive. Kisunla pricing details. Managed Healthcare Executive. July 2, 2024. https://www.managedhealthcareexecutive.com

[xiv] Centers for Medicare & Medicaid Services. (2024, April 1). Final CY 2025 Part D Redesign Program Instructions Fact Sheet [Fact sheet]. Retrieved from https://www.cms.gov/newsroom/fact-sheets/final-cy-2025-part-d-redesign-program-instructions-fact-sheet

[xv] Quest Diagnostics. (2024, April 22). Quest Diagnostics adds p‑tau217 blood biomarker testing to suite of services designed to assess risk and help aid diagnosis of Alzheimer’s disease [Press release]. Retrieved from https://newsroom.questdiagnostics.com/2024-04-22-Quest-Diagnostics-Adds-p-tau217-Blood-Biomarker-Testing-to-Suite-of-Services-Designed-to-Assess-Risk-and-Help-Aid-Diagnosis-of-Alzheimers-DiseasLe, Labcorp. (2025, August 18). Labcorp launches first FDA‑cleared blood test for Alzheimer’s disease [Press release]. Retrieved from https://ir.labcorp.com/news-releases/news-release-details/labcorp-launches-first-fda-cleared-blood-test-alzheimers-disease, Centers for Medicare & Medicaid Services. (2024, April 1). Final CY 2025 Part D Redesign Program Instructions Fact Sheet [Fact sheet]. Retrieved from https://www.cms.gov/newsroom/fact-sheets/final-cy-2025-part-d-redesign-program-instructions-fact-sheet.

[xvi] Pennsylvania Department of State. (n.d.). Electronic or remote notarization. Retrieved November 10, 2025, from https://www.pa.gov/agencies/dos/resources/notaries-resources-and-information/electronic-or-remote-notarization

[xvii] Simmons Hannibal, B. (n.d.). The Revised Uniform Fiduciary Access to Digital Assets Act (RUFADAA). Nolo. Retrieved September 2025, from https://www.nolo.com/legal‑encyclopedia/ufadaa.html

[xviii] Financial Crimes Enforcement Network. (2024, April 18). FinCEN issues analysis on elder financial exploitation [News release]. U.S. Department of the Treasury. Retrieved from https://www.fincen.gov/news/news‑releases/fincen-issues-analysis-elder-financial-exploitation

About the Author

Bronwyn Martin, PhD, MBA, CRPC^™, CMFC^™, ChFC^®, AEP^®, CFS^®, CLU^®, CLTC^® is a Financial Advisor with Martin’s Financial Consulting Group a financial advisory practice of Ameriprise Financial Services, LLC in Havre de Grace MD. She specializes in fee-based financial planning and asset management strategies and has been in practice for over 25 years. Dr. Martin also founded The Intersections Institute in 2026-a research thought leadership platform dedicated to studying decision-making at the intersections.