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Bill

S 9523

Relates to coverage for treatments to slow the progression of Alzheimer's disease and related dementias

2025 Regular Session Introduced by Joe Addabbo and 5 co-sponsors

New York insurers must cover medically necessary diagnostic tests and FDA-approved treatments to slow Alzheimer's progression, with no step therapy.

REFERRED TO INSURANCE
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Bill Summary · S 9523

Summary of Bill S. 9523 (2025-2026) – New York

Purpose and intent

S. 9523 seeks to require various health insurance products sold in New York to cover treatments and diagnostic testing intended to slow the progression of Alzheimer’s disease and related dementias. The bill aims to ensure access to FDA-approved treatments without requiring patients to undergo step therapy, thereby reducing barriers to medically necessary care for individuals with Alzheimer's and other dementias.

Key provisions and changes

  • Insurance coverage expansion for individual and group plans (medical/major medical and comprehensive-type coverage)

    • Insurance policies that provide medical, major medical, or similar comprehensive coverage must cover:
    • All medically necessary diagnostic testing.
    • FDA-approved treatments or medications prescribed to slow the progression of Alzheimer's disease and related dementias.
    • Coverage must align with FDA labeling and be determined by a physician licensed in New York.
    • Treatments and medications prescribed to slow progression are not subject to step therapy (i.e., no mandatory escalation through alternative therapies before the FDA-approved option is covered).

  • Similar requirements for group/blanket policies (insurers delivering group/blanket policies in New York)

    • Insurers offering or delivering group or blanket coverage must provide the same protections as above:
    • Coverage of medically necessary diagnostic testing.
    • Coverage of FDA-approved treatments or medications to slow progression, with no step therapy.

  • Coverage by certain medical expense organizations

    • Medical expense indemnity corporations, hospital service corporations, and health service corporations that provide medical/major medical/comprehensive-type coverage must:
    • Cover all medically necessary diagnostic testing.
    • Cover FDA-approved treatments or medications to slow progression, without step therapy.

  • Social services law alignment

    • The Social Services Law is amended to require coverage for the same scope of diagnostic testing and FDA-approved treatments, with no step therapy, for related dementia care.

Affected entities and individuals

  • Policyholders: Individuals with policies that provide medical, major medical, or similar comprehensive-type coverage, including group or blanket policies.
  • Insurers and health plans:
    • Health insurers issuing individual or group policies.
    • Medical expense indemnity corporations, hospital service corporations, and health service corporations.
  • Healthcare providers: Physicians licensed in New York who determine medical necessity and prescribe FDA-approved treatments.
  • Beneficiaries: People diagnosed with Alzheimer's disease or related dementias who rely on coverage to access diagnostic testing and disease-modifying therapies.

Implementation and timing

  • Effective date: The act takes effect on January 1 of the year following enactment.
  • Applicability: Applies to policies issued, renewed, modified, altered, or amended on or after the effective date.

Additional notes

  • The bill explicitly ties coverage to FDA-approved treatments and FDA labeling, ensuring treatments prescribed to slow disease progression are covered when medically appropriate.
  • Step therapy (requiring prior authorization of non-FDA-approved alternatives before the FDA-approved option) would not apply to the covered treatments under this act.

This bill, if enacted, would broadly enhance access to diagnostic testing and disease-modifying therapies for Alzheimer's and related dementias within New York’s private insurance market and certain health plan types, aligning payer requirements with physician expertise and federal labeling.

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

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