Illinois has become the first state to legislatively enact a requirement for state employee health insurance to provide Alzheimer’s treatment coverage.
State employees now will have access to all Food and Drug Administration-approved Alzheimer’s treatments after the state legislature approved an Alzheimer’s Association-backed initiative.
SB 3318 ensures that state employee health insurance plans provide coverage for Alzheimer’s treatments and medications when medically necessary, and it prohibits the use of so-called step therapy, which the Alzheimer’s Association Illinois chapter said can “unnecessarily” delay treatment by requiring individuals to take one or more alternative medications or treatments before accessing one prescribed by their doctor.
The bill also requires coverage of diagnostic imaging or tests to confirm an Alzheimer’s diagnosis.
The bill passed unanimously in both the Illinois House and Senate and now heads to Gov. Pritzker (D) for his signature. If signed, the bill goes into effect July 1, 2025.
“For individuals living with Alzheimer’s and their loved ones, access to effective treatment is a lifeline of hope,” state Sen. Laura Murphy (D), sponsor of the bill, said in a release. “By removing step therapy requirements, we reaffirm our commitment to supporting patients on their journey, providing them with the best possible chance for improved outcomes and enhanced quality of life.”
Although the bill doesn’t necessarily have a direct effect on assisted living providers, senior living leaders in the state said they generally support the measure.
“We support efforts to continue to combat the effects of Alzheimer’s disease and those that work to better understand its causes and reduce instances of it occurring,” Illinois Health Care Association / Illinois Center for Assisted Living President and CEO Matt Hartman told McKnight’s Senior Living.
LeadingAge Illinois said that although it would like to see these requirements apply to all health plans, “we understand this has to start somewhere.”
“Like many other advancements in care, our health plans need to recognize more quickly the benefits of new treatments and provide coverage for them,” LeadingAge Illinois President and CEO Angela Schnepf told McKnight’s Senior Living. “Such treatments cannot and should not be limited to only those that can afford to pay for them out of pocket, especially when they have a health plan that should be covering these costs.”
According to statistics cited by the National Center for Assisted Living, 31% of Illinois’ assisted living residents have an Alzheimer’s disease or dementia diagnosis.
Source: McKnights Seniorliving