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Bill

A 5062

Requires health insurance and Medicaid coverage for testing and treatments to slow progression of Alzheimer's disease and related disorders.

2026-2027 Regular Session Introduced by Clinton Calabrese and 13 co-sponsors

NJ health plans must cover FDA-approved Alzheimer’s diagnostic testing and treatments non-step-therapy, aligning with FDA labeling and physician orders.

Passed by the Assembly (78-0-1)
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Bill Summary · A 5062

Summary of Bill A 5062 (Session 222, New Jersey)

Main purpose and intent

  • Requires comprehensive health insurance policies and the Medicaid program to cover diagnostic testing and FDA-approved treatments or medications that aim to slow the progression of Alzheimer's disease and related disorders.
  • Ensures that coverage for these Alzheimer’s-related services is provided to the same extent as coverage for other medical conditions, with the specific protection that FDA-approved treatments for Alzheimer’s are not subject to step therapy.

Key provisions and changes

1) Hospital Service Corporation contracts
- Applicable to contracts delivered, issued, or renewed in New Jersey on or after the act’s effective date.
- Must cover all medically necessary diagnostic testing and FDA-approved treatments/medications to slow Alzheimer’s progression, as labeled by the FDA and ordered by a physician.
- Alzheimer’s-related treatments are not subject to step therapy.
- Applies only to contracts where the insurer reserves the right to change the premium.

2) Medical Service Corporation contracts
- Same structure as above (diagnostic testing and FDA-approved Alzheimer’s treatments), subject to the same non-step-therapy requirement.
- Applies where the medical service corporation reserves the right to change the premium.

3) Health Service Organization (HSO) contracts
- Similar requirements for coverage, with non-step-therapy protection and premium-reservation applicability.

4) Individual health insurance policies
- Requires coverage for Alzheimer’s diagnostic testing and FDA-approved treatments or medications, aligned with FDA labeling and physician determination.
- Non-step-therapy protection; applies if the insurer reserves the right to change the premium.

5) Group health insurance policies
- Mirrors the above: coverage for diagnostic testing and FDA-approved Alzheimer’s treatments, with non-step-therapy protection, and premium-reservation applicability.

6) Small employer health benefits plans
- Extends the same Alzheimer’s coverage and non-step-therapy protections to small group plans, including premium-reservation.

7) Health Maintenance Organization (HMO) contracts
- HMOs must provide coverage for diagnostic testing and FDA-approved treatments for Alzheimer’s, non-step-therapy, with premium-reservation noted for schedule of charges.

8) State Health Benefits Commission contracts
- The commission must ensure all relevant contracts (purchased after the act’s effective date) cover Alzheimer’s diagnostic testing and FDA-approved treatments, with non-step-therapy protections.

9) School Employees’ Health Benefits Commission contracts
- Requires the same Alzheimer’s coverage and non-step-therapy protection for contracts purchased after enactment.

10) Medicaid provisions
- Department of Human Services must ensure Medicaid covers all medically necessary Alzheimer’s diagnostic testing and FDA-approved treatments, with non-step-therapy protection.
- DHS to pursue federal/state plan amendments or waivers as needed to implement the act and secure federal financial participation.

11) Effective date
- The act takes effect on the 180th day after enactment.
- Applies to contracts delivered, issued, executed, or renewed on or after that date.

Who would be affected

  • A wide range of health coverage products in New Jersey, including:
    • Hospital service corporations
    • Medical service corporations
    • Health service corporations
    • Individual and group health insurance policies
    • Small employer health benefits plans
    • Health Maintenance Organizations (HMOs)
    • State Health Benefits Program (SHBP)
    • School Employees’ Health Benefits Program (SEHBP)
    • New Jersey Medicaid program
  • The act also affects contracts the State enters into for employee benefits programs.

Procedural and timeline aspects

  • Introduced May 14, 2026; referred to Assembly Financial Institutions and Insurance Committee.
  • Effective date: 180 days after enactment.
  • Applies to contracts issued or renewed after the effective date; existing contracts may be grandfathered unless otherwise specified.

Notable details

  • Coverage scope includes all medically necessary diagnostic testing and FDA-approved treatments/medications to slow Alzheimer’s progression, as labeled by the FDA and prescribed by a physician.
  • The bill explicitly prohibits step therapy (utilization review that would require trying less expensive options before FDA-approved Alzheimer’s treatments) for these specific Alzheimer’s-related therapies.
  • The bill emphasizes alignment with FDA labeling and physician determination as the basis for coverage decisions.

This summary provides the substantive content and potential impact for readers seeking to understand how A 5062 would change coverage for Alzheimer’s disease testing and treatments in New Jersey.

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

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