Health care coverage: dementia.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Enrolled
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Overview
This bill aims to improve health care coverage for individuals living with Alzheimer’s disease and other related dementias. It requires health care service plans and health insurance policies issued on or after January 1, 2027, to cover all medically necessary treatments and medications approved by the FDA for these conditions. The bill also prohibits step therapy protocols for these treatments, unless certain conditions are met, and ensures coverage criteria align with FDA-approved indications. Furthermore, it clarifies that no reimbursement is required from the state for local agencies or school districts due to the creation of a new crime.
Key provisions
- Requires health care service plans and health insurance policies to cover FDA-approved treatments for Alzheimer’s disease and related dementias.
- Prohibits step therapy protocols for these treatments, except under specific circumstances.
- Ensures coverage criteria for these treatments align with FDA-approved indications.
- Specifies that pharmaceutically equivalent drug products are not required to be covered if multiple FDA-approved options exist.
- Clarifies that authorization for medically necessary treatments is considered an exigent circumstance.
- Excludes certain types of policies (e.g., vision-only, dental-only) from the coverage requirements.
- States that no state reimbursement is required for local agencies or school districts due to the creation of a new crime.
Who is affected
Bill text
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Sponsors
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6 on record
Primary sponsor
Cosponsors
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