Sponsors (3)
Requires private group/individual plans and Medicaid to cover Alzheimer’s biomarker testing with parity, bans step therapy, and accelerates prior authorization decisions.
The bill expands and speeds access to Alzheimer’s biomarker testing—especially for seniors and Medicaid enrollees—improving timely diagnosis and clinician decision-making, but it raises public and private costs, implementation burdens, and some risks of coverage gaps or unnecessary testing.
People at risk for or living with Alzheimer's — including seniors and Medicaid enrollees — would get mandatory coverage for FDA/NCD/guideline-qualifying biomarker tests and face lower out-of-pocket costs, increasing equitable access to diagnosis and treatment eligibility.
Patients needing biomarker testing would face much faster prior-authorization timelines (72 hours, 24 hours if urgent) and automatic approval when plans miss deadlines, reducing delays to timely testing and care.
Clinicians and patients would be protected from step-therapy requirements for biomarker testing, preserving clinician judgment and preventing forced trials of other interventions before appropriate testing.
Mandatory coverage expansion for biomarker testing will increase insurer and Medicaid spending, which could translate into higher premiums, greater taxpayer/state costs, or fiscal pressure on Medicaid budgets over time.
Automatic approval when plans miss prior-authorization deadlines could encourage increased use of testing before clinical review, raising the risk of unnecessary testing and related costs.
Limiting mandated coverage to tests that meet specific criteria (FDA label, Medicare NCD, or clinical guidelines) may leave some clinically useful biomarker tests uncovered, creating gaps and confusion for patients and providers.
Based on analysis of 2 sections of legislative text.
Official title: To amend title XXVII of the Public Health Service Act and title XIX of the Social Security Act to require coverage of Alzheimer's biomarker testing under group health plans, group and individual health insurance coverage, and the Medicaid program.
Introduced July 22, 2026 by Jake Auchincloss · Last progress July 22, 2026
Requires private group and individual health plans, Medicaid, and issuers to cover Alzheimer’s biomarker testing and treat that testing like predominant medical/surgical benefits. It bars step therapy for the tests, requires fast prior authorization decisions (72 hours normally, 24 hours if urgent), and mandates automatic approval if the plan misses the deadline. Adds biomarker testing to mandatory Medicaid medical assistance and directs the NIH Director to hire the National Academies to study the clinical and policy value of Alzheimer’s biomarker testing and report to Congress annually for three years. The private-insurance rules apply to plan years starting one year after enactment; the Medicaid changes apply to calendar quarters beginning one year after enactment.