Alzheimer's Association pushing more insurers to cover biomarker testing

Dec. 26--Early diagnosis leads to more effective treatment and more time with loved ones when it comes to dementia, the Alzheimer's Association says, which is why the organization joined with other groups to encourage health insurers to cover the cost of biomarker testing.

Biomarkers, short for biological markers, can show whether a disease is present or if a person is at risk for developing a disease. Continued progress around biomarker testing regarding blood-based amyloids -- the type of protein that can clump together and cause plaques in the brain, leading to dementia -- is likely to lead to new diagnostic tools coming to market within the next couple of years, the Alzheimer's Association says.

"To put someone on a potential path to treatment through biomarker testing is critically important," said Trey Addison, public policy director for Alzheimer's Association Ohio.

The Alzheimer's Association recently joined a national coalition of 50 health organizations, including the American Cancer Society's Cancer Action Network, the ALS Association and the Arthritis Foundation, pushing to expand insurance coverage for comprehensive biomarker testing.

Ohio House Bill 24 will advance diagnosis of Alzheimer's for many in Ohio, Alzheimer's Association public policy staff say. This legislation would require Medicaid and state-regulated insurance plans to cover the cost of biomarker testing, said Camren Harris, Ohio research champion and public policy manager for Alzheimer's Association Ohio.

H.B. 24 isn't just for dementia, as it is coverage for whenever there is a need for a biomarker test when it is supported by medical and scientific evidence, the bill analysis says.

Ohioans who are battling cancer and other illnesses will have a better chance of surviving and thriving with access to biomarker testing, said State Rep. Andrea White, R-Kettering, H.B. 24 s primary sponsor.

"I am sure everyone here has been touched by cancer in some way, whether it's a family member, a friend, a coworker. It is deeply personal. As a grandmother, a daughter-in-law and a sister-in-law, I have watched my family members suffer greatly from this disease. I've also seen their lives extended with the miracles of God and the blessings of modern medicine," White said in her sponsor testimony before the Ohio House Insurance Committee.

Nationally, 12 states have already enacted legislation requiring coverage in both public and private insurance plans, according to the Alzheimer's Association -Arizona, California, Georgia, Illinois, Kentucky, Louisiana, Maryland, Minnesota, New Mexico, Oklahoma, Rhode Island and Texas. Similar legislation is awaiting the governor's signature in New York.

Insurance providers, including CareSource and AmeriHealth Caritas Ohio, declined to comment on Ohio's pending legislation. The Ohio Department of Medicaid also declined to comment on this pending legislation, but Ohio Medicaid does cover some biomarker testing and has a billing code for providers to be reimbursed for certain kinds of testing.

The Alzheimer's Association's support for this bill comes as developments in treatments for Alzheimer's and other forms of dementia are advancing. With two FDA-approved drugs and a third on the way, research on dementia has reached "the age of treatment."

"We didn't know when we'd get to this point so (fast). We're literally building upon research and data from our last two drugs into this one," Harris said about the latest drug researchers have developed, donanemab, which has been the most effective so far. Donanemab is a monoclonal antibody like the FDA-approved drugs for dementia -- aducanumab and lecanemab. Those two drugs are marketed as Adulhelm and Leqembi, respectively.

"It was in the late stage of clinical trials and nearly half of the study participants who received the drug in the early stage of the disease had no clinical progression at one year," Harris said about donanemab.

The treatments tend to be aimed at patients who are at the beginning of experiencing Alzheimer's or other forms of dementia, making it important for people with those diseases to know sooner whether they have it. The sooner they get on treatment, the longer they can potentially live on their own, stay in the workforce, and support themselves, Addison said.

"It puts me on a faster path to treatment so I can actually stay in the workforce, so I can stay living a rather sustainable life. All of those things are critically important," Addison said.

Ohio H.B. 24 is currently before the House Insurance Committee.

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