Patients’ choices and eligibility for anti‐amyloid therapy in Japan's universal insurance

Abstract INTRODUCTION We examined factors influencing eligibility and treatment initiation for anti‐amyloid therapy in a real‐world setting under Japan's universal insurance. METHODS We established a specialized disease‐modifying therapy (DMT) clinic with two‐step screening aligned with optimal use guidelines. We recorded patient flow and reasons for exclusion from December 2023–April 2025 and assessed predictors of initiation among attendees. RESULTS Of 456 self‐referred patients, 247 (54.2%) were excluded at first screening, mainly for advanced stage. Including 107 physician referrals, 312 attended the DMT clinic; 93 did not proceed (80 declined; 13 ineligible). Second‐stage screening excluded 44 for amyloid‐β negativity and 33 for magnetic resonance imaging (MRI) contraindications. Overall, 131 patients (42.0% of attendees) initiated therapy. In multivariable analysis, older age (≥75 years), male sex, and higher Mini‐Mental State Examination (MMSE) scores (27–30) were independently associated with a lower likelihood of initiation. DISCUSSION Universal insurance expands access, yet safer, less burdensome regimens and earlier intervention may improve uptake.