This bill mandates that health insurance carriers, including hospital service corporations, medical service corporations, health maintenance organizations, and the State and School Employees' Health Benefits Programs, provide coverage for all medically necessary diagnostic testing and U.S. Food and Drug Administration (FDA)-approved treatments or medications aimed at slowing the progression of Alzheimer's disease and related disorders. The coverage must be in accordance with the FDA label as determined by a physician. Additionally, the bill specifies that such coverage cannot be subject to any step therapy requirements, ensuring that patients have direct access to the necessary treatments without additional barriers.
Furthermore, the bill extends these coverage requirements to the State Medicaid Program, ensuring that individuals served under Medicaid also receive the same benefits for diagnostic testing and FDA-approved treatments for Alzheimer's disease. The Commissioner of Human Services is tasked with applying for any necessary state plan amendments or waivers to implement these provisions and secure federal financial participation for Medicaid expenditures. The act is set to take effect 180 days after enactment and will apply to contracts delivered, issued, executed, or renewed on or after that date.