Lecanemab Access Disparities Limit Equity

Lecanemab access disparities are raising red flags across the healthcare community, as new research reveals that this novel Alzheimer’s therapy is predominantly reaching a narrow slice of the patient population. Approved in July 2023 and covered by Medicare, lecanemab was expected to usher in a new era of disease-modifying treatment for Alzheimer’s disease (AD). However, the treatment’s reach appears skewed—primarily benefiting white, urban-dwelling, higher-income male patients.

A recent study published in JAMA Network Open underscores that the introduction of lecanemab, while medically significant, has unintentionally mirrored long-standing patterns of unequal healthcare access in the United States.

Who Is Receiving Lecanemab?

The study examined Medicare beneficiaries who used lecanemab from July 2023 to March 2024, comparing them to the broader population of patients diagnosed with AD or mild cognitive impairment (MCI). The findings were eye-opening:

• 90.5% of users were White

• 88% lived in urban areas

• 98.7% had higher socioeconomic status

• 48.5% were male

In contrast, among 842,192 Medicare patients with AD or MCI:

• Only 82% were White

• 82.1% were urban residents

• 75.3% had higher SES

• 36.4% were male

This suggests a 6-fold higher usage among White patients compared to Black patients, and 24-fold higher among high-SES patients versus lower-income groups.

Why Lecanemab Access Disparities Persist

While the high annual cost of $26,000—and an additional $7,000 in related care—explains part of the gap, experts stress that lecanemab access disparities are rooted in more than economics. Strict treatment eligibility, limited awareness, and barriers tied to geography and race contribute to unequal access.

“These disparities should concern all policymakers,” said Frank Zhou, the study’s lead author. “We must proactively design better systems to ensure equitable access to all future Alzheimer’s treatments—not just for those who can afford or navigate the complex process.”

Future Considerations for Medicare

With real-world data now available, experts call on Medicare to reassess the cost-effectiveness and coverage of lecanemab. Given the therapy’s modest benefits and serious side effects, some argue that investments might be better directed toward caregiver support and dementia care services.

“Lecanemab’s rollout mirrors historic inequities in U.S. healthcare,” said co-author Dr. John Mafi. “As we move forward, our focus must shift from innovation alone to equitable implementation.”

For more information: Zhou, F. F., et al. (2025). Disparities in Early Lecanemab Uptake Among US Medicare Beneficiaries. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2025.11711.