Leqembi (lecanemab-irmb)
EISAI AND BIOGEN
- Alzheimer’s Disease
- 10 mgs per kg IV every 2 weeks
- Need patient MRI before and during treatment to check for ARIA
Instructions
1 – Please open authorization forms (above). Fill out the forms on your computer, save and print.
2 – Open Physician Orders for the office of your choice (above). Save to your computer, print and fill out.
3 – The following tests should be performed and test results faxed to Pacific Infusion before the patient’s first visit: Lecanemab-irmb – MRI
4 – Fax the following to Pacific Infusion Center (310) 297-9222:
ㅤ• Completed and signed forms/order
ㅤ• Copy of the patient’s insurance card(s)
ㅤ• Demographics
ㅤ• OV notes
ㅤ• Tried and failed medications
ㅤ• Labs
ㅤ• Drug Enrollment Forms
5 – After the patient’s infusion appointment, our nurses will fax a copy of the infusion notes to your office.
