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Bill

SB 950

Health care coverage: dementia.

2025-2026 Regular Session Introduced by Laurie Davies and 5 co-sponsors

Requires health plans to cover all FDA-approved Alzheimer’s/dementia treatments and bans step therapy for these, with expedited access and outpatient drug coverage where applicable

Referred to Com. on HEALTH.
#healthcarecoverage #dementia
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Bill Summary · SB 950

Overview

SB 950 (2025-2026, California) would require health care service plans and health insurance policies to cover all medically necessary treatments or medications for Alzheimer’s disease and related dementias, effective January 1, 2027. The bill also prohibits step therapy (prior authorization sequencing) for FDA-approved treatments for these conditions, with limited exceptions, and ensures certain nonself-administered therapies and outpatient prescription drug coverage when applicable. It creates a state-mandated local program for willful violations and clarifies applicability, exemptions, and administrative provisions.

Purpose and intent

  • Ensure comprehensive coverage for FDA-approved treatments and medications for Alzheimer’s disease and related memory impairments.
  • Remove barriers to access by prohibiting step therapy protocols as a prerequisite for coverage of these FDA-approved treatments.
  • Align coverage with medical necessity as determined by a health care provider and FDA approvals.
  • Improve access to both self-administered and nonself-administered treatments (where the plan covers nonself-administered therapies as a medical benefit, the bill requires outpatient prescription drug coverage for those therapies).

Key provisions

  • Coverage scope:
    • Health care service plans (issued, amended, or renewed on/after Jan 1, 2027) must cover all medically necessary treatments or medications approved by the FDA for Alzheimer’s disease or related dementia, as determined by a health care provider.
    • Coverage applies across medical benefits, outpatient prescription drug benefits, or both.
    • Does not require coverage of pharmaceutically equivalent drugs if the FDA approves multiple equivalent options, unless required by law.
  • Step therapy prohibition:
    • Starting Jan 1, 2027, plans/insurers cannot impose step therapy as a prerequisite to coverage for FDA-approved treatments for Alzheimer’s or memory-related conditions, with an exception if at least one antiamyloid therapy is covered without step therapy.
    • Step therapy prohibition applies to both self-administered and physician-administered drugs.
  • Exceptions and utilization management:
    • Utilization management (e.g., prior authorization) remains allowed to determine medical necessity, but determinations must be consistent with how other illnesses are evaluated.
    • Coverage criteria cannot be more restrictive than FDA-approved indications.
  • Nonself-administered therapies:
    • If a plan covers nonself-administered FDA-approved treatments for memory-related conditions, those therapies must also be available as an outpatient prescription drug benefit.
  • Expedited access:
    • Plans must maintain an expeditious process for providers to obtain authorization for FDA-approved treatments, treating memory-related conditions as an exigent circumstance.
  • Exemptions:
    • The act does not apply to dental-only, vision-only, accident-only, specified disease, hospital indemnity, or Medicare supplement policies, and certain Medi-Cal managed care contracts.
  • Criminal penalty and local costs:
    • Willful violations by a plan would be crimes; the bill creates a state-mandated local program.
    • The Legislature states no reimbursement is required for local agencies/school districts for this act.

Affected entities

  • Health care service plans (e.g., HMOs) regulated under the Knox-Keene Act.
  • Health insurance policies regulated by the Insurance Code.
  • Providers prescribing FDA-approved Alzheimer’s/dementia treatments.
  • Patients with Alzheimer’s disease or related memory impairment seeking FDA-approved treatments.
  • Local government entities may incur related enforcement costs (subject to the bill’s reimbursement provisions).

Timelines and procedural notes

  • Effective date for coverage requirements: January 1, 2027.
  • Referred through the 2025-2026 Senate/Assembly process and amendments; action history shows multiple committee referrals and floor actions, with passage in the Senate and referral to the Assembly as of May 2026.
  • The bill includes standard constitutional language regarding no required local reimbursement, except for mandated local programs (with specified exemptions).

Potential impact

  • Increases in health plan/insurer coverage for Alzheimer’s/dementia treatments, reducing out-of-pocket costs for patients and streamlining access to FDA-approved options.
  • Possible shift in plan design to minimize administrative barriers (e.g., removal of step therapy requirements) and to ensure outpatient drug coverage for nonself-administered therapies.
  • Providers may experience faster authorization processes for FDA-approved treatments.
  • Potential administrative and cost implications for issuers and local jurisdictions due to the crime penalty for willful violations (though reimbursement obligations are limited by the bill).

Note: This summary reflects the bill text as presented and the accompanying legislative digest.

Compiled from official sources — confirm details with the bill’s official record.

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