Sponsors (2)
The bill expands and speeds access to Alzheimer’s biomarker testing—improving early diagnosis and equity for low-income and Medicare populations—at the cost of higher public and private spending, potential administrative burdens, and some risk of uncovered tests or unnecessary use.
People at risk for or with Alzheimer's (including seniors) would get coverage for biomarker tests used for early detection, diagnosis, and treatment eligibility, reducing out-of-pocket costs for these patients.
Medicaid enrollees would receive mandatory coverage for these biomarker tests 'in the same manner' as private plans, increasing access for low-income individuals who otherwise face coverage gaps.
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 in diagnosis and treatment access.
Insurers and Medicaid programs will face higher spending to cover these tests, which could translate into higher premiums for private enrollees or increased state Medicaid costs funded by taxpayers.
Limiting mandated coverage to tests that meet specific criteria (FDA label, Medicare national coverage determination, or professional guidelines) may still leave some clinically useful tests uncovered, creating confusion and gaps for patients and providers.
Automatic approval when insurers miss prior-authorization deadlines could increase use of testing before clinical review, raising the risk of unnecessary tests and additional downstream costs.
Based on analysis of 2 sections of legislative text.
Requires private plans and Medicaid to cover Alzheimer’s biomarker testing, bans step therapy, speeds prior authorization, and mandates equitable access.
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 and Medicaid to cover Alzheimer’s biomarker testing without extra cost-sharing or more restrictive limits than predominant medical/surgical benefits. It bans step therapy for these tests, sets fast prior authorization deadlines with automatic approval for missed deadlines, mandates equitable access (including minimally invasive options), and ties coverage to FDA labeling, Medicare coverage decisions, or clinical guidelines. The bill also directs the NIH to contract with the National Academies to study the value of biomarker testing and report to Congress annually for three years.