A “particularly egregious” gap in TRICARE drug coverage for a promising Alzheimer’s medication may be addressed by the must-pass defense authorization bill and has drawn the attention of four key senators, all of whom were thanked for their efforts by The Military Coalition in a recent letter.

The coalition represents about 5.5 million members of the uniformed services community and counts MOAA among its founding members and health care policy leaders. The Nov. 4 letter addresses Leqembi, a drug with full approval from the Food and Drug Administration to treat Alzheimer’s disease but with no coverage under TRICARE Prime or Select. TRICARE For Life beneficiaries have partial coverage via Medicare, per the letter, but must pay $365 per month for the medication – money that does not count against the annual TRICARE out-of-pocket cap.

[Read the Letter | Ask Your Lawmakers to Fix This Coverage Gap]

The drug, which targets the disease in its early stages, has been covered by the VA for more than a year. Sens. Susan Collins (R-Maine), Shelley Moore Capito (R-W.Va.), Jon Tester (D-Mont.), and Mark Warner (D-Va.) wrote to top DoD health officials in May asking for an immediate update to TRICARE policy allowing coverage for Leqembi and similar treatments.

Along with approved Medicare and Medicaid coverage for the drug, other private plans such as the BlueCross BlueShield Federal Employee Program cover the medication. This creates a “parity gap” between TRICARE and other providers, according to the letter.

The gap “has persisted for 16 months with no indication an update is pending,” the letter states. “Treatment for [Alzheimer’s disease] is most effective when administered early – delays can result in irreversible disease progression – making this prolonged TRICARE coverage gap particularly egregious.”

[RELATED: What More Pharmacy Closures Could Mean for Your TRICARE Benefit]

The Senate version of the FY 2025 National Defense Authorization Act (NDAA) would require DoD to provide a report on the decision not to cover Leqembi and “notes TRICARE’s role in facilitating timely and equitable beneficiary access to novel therapeutics,” per the letter. MOAA appreciates Senator Collins submitting the NDAA amendment which resulted in this important provision.

Keeping Your Health Care Benefit Strong

Ensuring TRICARE coverage keeps pace with private sector plans is critical to maintaining the value of your earned health care benefit. MOAA has worked toward this goal on multiple fronts, from encouraging reevaluation of drug coverage tiers to addressing the parity gap faced by beneficiaries seeking coverage for young adult dependents.

By partnering with fellow members of The Military Coalition and garnering bipartisan support for initiatives addressing these concerns and others, MOAA hopes to protect access to high quality care for military members, retirees, and their families and survivors.

Ask your lawmakers to close this coverage gap, and keep up with the latest on this work and other advocacy priorities at MOAA’s Advocacy News page.