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Bill

A 10748

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

2025 Regular Session Introduced by Vivian Cook and 3 co-sponsors

Requires private and public health coverage to cover medically necessary diagnostic testing and FDA-approved treatments to slow Alzheimer's progression, with no step therapy.

REFERRED TO INSURANCE
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Bill Summary · A 10748

Overview

Bill A. 10748 (2025-2026, New York) would require certain health insurance policies and public coverage programs to include coverage for diagnostic testing and FDA-approved treatments or medications that slow the progression of Alzheimer's disease and related dementias. The measure prohibits step therapy for these treatments and expands several statutory coverage requirements to align with this goal. The act would take effect January 1 following enactment and apply to policies issued or renewed on or after that date.

Purpose and Intent

  • To ensure that individuals diagnosed with Alzheimer's disease or related dementias have access to medically necessary diagnostic testing and FDA-approved treatments designed to slow disease progression.
  • To prohibit step therapy (prior authorization or stepwise sequencing) for these treatments, ensuring timely access to prescribed therapies.
  • To align insurance and public assistance program coverage with current medical guidance for slowing disease progression.

Key Provisions

  1. Insurance Law – Individual and Group Policies

    • Adds new paragraph (11-d) to subsection (i) of §3216.
    • Mandates that every policy providing medical, major medical, or similar comprehensive-type coverage cover:
      • All medically necessary diagnostic testing.
      • FDA-approved treatments or medications prescribed to slow progression of Alzheimer's disease and other dementias, as labeled by the FDA.
      • Coverage is determined by a physician licensed in all branches of medicine.
      • Coverage for these treatments shall not be subject to step therapy.

  2. Insurance Law – Group Policies

    • Adds new paragraph (11-d) to subsection (l) of §3221.
    • Requires insurers issuing or delivering group or blanket policies in New York to cover:
      • All medically necessary diagnostic testing.
      • FDA-approved treatments or medications prescribed to slow progression of Alzheimer's disease and related dementias, as labeled by the FDA.
      • Determination by a physician licensed in all branches of medicine.
      • No step therapy for these treatments.

  3. Insurance Law – Medical Expense Indemnity/Hospital Service/Health Service Corporations

    • Adds new subsection (p-2) to §4303.
    • Requires these entities to provide:
      • Coverage for all medically necessary diagnostic testing.
      • FDA-approved treatments or medications to slow progression of Alzheimer's disease and other dementias (per FDA label, as determined by a physician).
      • No step therapy for these treatments.

  4. Social Services Law – Public Coverage

    • Adds new paragraph (mm-1) to subdivision 2 of §365-a.
    • Applies to all medically necessary diagnostic testing and FDA-approved treatments or medications prescribed to slow progression of Alzheimer's disease and related dementias (per FDA label, as determined by a physician).
    • Requires that such coverage not be subject to step therapy.

  5. Effective Date

    • The act would take effect January 1 of the year following enactment.
    • Applies to policies and contracts issued, renewed, modified, or amended on or after that effective date.

Who is Affected

  • Private health insurance policyholders with medical, major medical, or similar comprehensive coverage (individual and group policies).
  • Group/blanket policy issuers and administrators delivering coverage in New York.
  • Medical expense indemnity corporations, hospital service corporations, and health service corporations offering applicable coverage.
  • Public coverage programs subject to the Social Services Law provisions (as applicable in New York).

Potential Impact

  • Expanded access to diagnosis and disease-modifying-like treatments for Alzheimer's and related dementias in both private and public coverage contexts.
  • Elimination of step therapy barriers for these specific treatments, potentially reducing delays in care.
  • Increased clarity for providers and patients about covered services and required therapies.
  • Potential cost implications for insurers and public programs due to broader coverage requirements, though the bill does not specify premium or reimbursement adjustments.

Notes

  • The bill references FDA-approved treatments or medications used to slow progression, to be interpreted in accordance with FDA labeling and physician assessment.
  • The exact list of covered treatments would be determined by FDA approvals in effect at the time of treatment and by physician discretion within licensed practice.

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

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