Read the full stored bill text
A5062
ASSEMBLY, No. 5062
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MAY 14, 2026
Sponsored by:
Assemblywoman� CAROL A. MURPHY
District 7 (Burlington)
Assemblywoman� TENNILLE R. MCCOY
District 14 (Mercer and Middlesex)
Assemblyman� ROBERT J. KARABINCHAK
District 18 (Middlesex)
Co-Sponsored by:
Assemblywoman Haider, Assemblymen Sampson, Angelozzi,
Assemblywoman Brennan, Assemblyman Calabrese and Assemblywoman Quijano
SYNOPSIS
���� Requires health insurance and Medicaid coverage for
testing and treatments to slow progression of Alzheimer�s disease and related
disorders.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning health insurance coverage for Alzheimer's
disease and supplementing various parts of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� a.� A hospital service
corporation contract that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to P.L.1938,
c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by
the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide coverage for all medically necessary diagnostic testing
and U.S. Food and Drug Administration-approved treatments or medications
prescribed to slow the progression of Alzheimer�s disease and related disorders,
in accordance with the U.S. Food and Drug Administration label, as determined
by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those hospital service corporation contracts in which the hospital
service corporation has reserved the right to change the premium.
���� 2.��� a.� A medical service
corporation contract that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74
(C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the
Commissioner of Banking and Insurance, on or after the effective date of this
act, shall provide coverage for all medically necessary diagnostic testing and
U.S. Food and Drug Administration-approved treatments or medications prescribed
to slow the progression of Alzheimer�s disease and related disorders, in
accordance with the U.S. Food and Drug Administration label, as determined by a
physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those medical service corporation contracts in which the medical
service corporation has reserved the right to change the premium.
���� 3.��� a.� A health service
corporation contract that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to P.L.1985,
c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by
the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide coverage for all medically necessary diagnostic testing
and U.S. Food and Drug Administration-approved treatments or medications
prescribed to slow the progression of Alzheimer�s disease and related disorders,
in accordance with the U.S. Food and Drug Administration label, as determined
by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those health service corporation contracts in which the health service
corporation has reserved the right to change the premium.
���� 4.��� a.� An individual health
insurance policy that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1
et seq., or approved for issuance or renewal in this State by the Commissioner
of Banking and Insurance, on or after the effective date of this act, shall
provide coverage for screening for all medically necessary diagnostic testing
and U.S. Food and Drug Administration-approved treatments or medications
prescribed to slow the progression of Alzheimer�s disease and related disorders,
in accordance with the U.S. Food and Drug Administration label, as determined
by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the policy, except
that coverage of U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those individual health insurance policies in which the insurer has
reserved the right to change the premium.
���� 5.��� a.� A group health
insurance policy that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to
N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by
the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide coverage for screening for all medically necessary
diagnostic testing and U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer�s disease and
related disorders, in accordance with the U.S. Food and Drug Administration
label, as determined by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the policy, except
that coverage of U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those group health insurance policies in which the insurer has
reserved the right to change the premium.
���� 6.��� a.� An individual health
benefits plan that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to P.L.1992,
c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State
by the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide coverage for screening for all medically necessary
diagnostic testing and U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer�s disease and
related disorders, in accordance with the U.S. Food and Drug Administration
label, as determined by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the plan, except
that coverage of U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those health benefits plans in which the carrier has reserved the
right to change the premium.
���� 7.��� a.� A small employer
health benefits plan that provides hospital and medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to P.L.1992,
c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State
by the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide coverage for all medically necessary diagnostic testing
and U.S. Food and Drug Administration-approved treatments or medications
prescribed to slow the progression of Alzheimer�s disease and related disorders,
in accordance with the U.S. Food and Drug Administration label, as determined
by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the plan, except
that coverage of U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those health benefits plans in which the carrier has reserved the
right to change the premium.
���� 8.��� a.� A health maintenance
organization contract for health care services that is delivered, issued,
executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et
seq.), or approved for issuance or renewal in this State by the Commissioner of
Banking and Insurance, on or after the effective date of this act, shall
provide coverage for all medically necessary diagnostic testing and U.S. Food
and Drug Administration-approved treatments or medications prescribed to slow
the progression of Alzheimer�s disease and related disorders, in accordance
with the U.S. Food and Drug Administration label, as determined by a physician.
�
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� This section shall
apply to those contracts for health care services under which the health
maintenance organization has reserved the right to change the schedule of
charges for enrollee coverage.
���� 9.��� a.� The State Health
Benefits Commission shall ensure that every contract purchased by the
commission on or after the effective date of this act that provides hospital
and medical expense benefits shall provide coverage for all medically necessary
diagnostic testing and U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer�s disease and
related disorders, in accordance with the U.S. Food and Drug Administration
label, as determined by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� 10.� a.� The School Employees�
Health Benefits Commission shall ensure that every contract purchased by the
commission on or after the effective date of this act that provides hospital
and medical expense benefits shall provide coverage for all medically necessary
diagnostic testing and U.S. Food and Drug Administration-approved treatments or
medications prescribed to slow the progression of Alzheimer�s disease and
related disorders, in accordance with the U.S. Food and Drug Administration
label, as determined by a physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� 11.� a.� Notwithstanding any
State law or regulation to the contrary, the Department of Human Services shall
ensure that expenses incurred for all medically necessary diagnostic testing
and U.S. Food and Drug Administration-approved treatments or medications prescribed
to slow the progression of Alzheimer�s disease and related disorders, in
accordance with the U.S. Food and Drug Administration label, as determined by a
physician, shall be provided to persons served under the Medicaid program,
established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the program,
except that coverage of U.S. Food and Drug Administration-approved treatments
or medications prescribed to slow the progression of Alzheimer's disease or
another related disorder pursuant to this section shall not be subject to any
step therapy requirements.
���� c.���� The Commissioner of
Human Services shall apply for such State plan amendments or waivers as may be
necessary to implement the provisions of this act and to secure federal
financial participation for State Medicaid expenditures under the federal
Medicaid program.
���� 12.� This act shall take
effect on the 180th day following the date of enactment, and shall apply to
contracts delivered, issued, executed, or renewed on or after that date.
STATEMENT
���� This bill requires health
insurance carriers (insurance companies, health, hospital, and medical service
corporations, health maintenance organizations, and State and School Employees'
Health Benefits Programs) and the State Medicaid Program to provide coverage
for all medically necessary diagnostic testing and U.S. Food and Drug
Administration-approved treatments or medications prescribed to slow the
progression of Alzheimer�s disease and related disorders, in accordance with
the U.S. Food and Drug Administration label, as determined by a physician.
���� The bill provides that coverage
of U.S. Food and Drug Administration-approved treatments or medications
prescribed to slow the progression of Alzheimer's disease or another related
disorder may not be subject to any step therapy requirements.