ILLINOIS — A new law signed by Gov. J.B. Pritzker this week has positioned Illinois as the first state in the nation to mandate insurance coverage for FDA-approved Alzheimer’s disease treatments, diagnostic testing, and medication — a development that advocates are calling “life changing” for families across the state.
The legislation will ensure that state-regulated private insurance plans cover both diagnostic evaluations and medications like Leqembi, a recently approved Alzheimer’s drug with an annual cost of $26,500, removing a key barrier for early intervention in a disease that affects over 250,000 Illinoisans aged 65 and older, according to the Alzheimer’s Association Illinois Chapter.
A Groundbreaking First in the Nation
Effective Jan. 1, 2027, the new law requires insurance plans issued, amended, or renewed in Illinois to cover:
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FDA-approved treatments and medications for Alzheimer’s
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Diagnostic testing necessary to confirm the disease
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Exemptions from “step therapy” — a controversial cost-control method that forces patients to try cheaper, less effective drugs before accessing the prescribed treatment
David Olsen, director of state affairs for the Alzheimer’s Association Illinois chapter, emphasized the urgency of removing delays in treatment:
“We can’t use this fail-first method because if we do, somebody may progress to a point where they are no longer eligible for these drugs. Early diagnosis and timely treatment will be life-changing for Illinois families.”
Personal Story: The Zumdahl Family’s Journey
Mark and Margaret Zumdahl, a couple from Sterling, know firsthand the difference early access to treatment can make. Margaret, diagnosed with Alzheimer’s nine years ago, participated in the clinical trial that led to the approval of one of the first drugs in two decades.
Though she received a placebo during the early stages of the trial, Margaret eventually began infusions of the actual drug, which helped stabilize the disease’s progression.
“She had a PET scan at the end, and it showed she was plaque-neutral. That means her brain’s amyloid levels were no worse than someone without Alzheimer’s,” Mark said. “The drug worked — but she started it three to four years after symptoms began.”
Millions Now Eligible for Coverage
The new law primarily targets individuals with private insurance who are not covered by Medicare or Medicaid. Olsen estimates that this change will impact 3.5 to 4 million residents, nearly half of the state’s population.
“A person with early-onset Alzheimer’s — possibly in their 40s or 50s — won’t qualify for Medicare. Without private insurance coverage, they’d be left without options,” Olsen explained. “This law changes that.”
However, it’s important to note that federally regulated plans (ERISA plans) are excluded from the coverage mandate.
Why It Matters: Treatment Access and Equity
In recent years, Alzheimer’s treatment has evolved significantly. With drugs like Leqembi receiving FDA approval, access has become a matter of affordability and insurance compliance. Previously, many patients couldn’t access these drugs until they had exhausted other, often ineffective, medications.
The passage of this bill reflects a shift in how Illinois policymakers are addressing long-term health conditions, particularly those affecting an aging population.
“This is a big deal for Illinois families,” said Olsen. “It bridges a gap in care and removes financial obstacles for thousands of households who previously had no realistic path to treatment.”
Implementation Timeline and Cost Considerations
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Effective Date: Jan. 1, 2027
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Applies To: Illinois-regulated insurance plans (not federal ERISA plans)
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Treatment Covered: Diagnostic tests, prescription drugs, and infusion therapies approved by the FDA
Those already on Medicare or Medicaid are generally covered for Alzheimer’s treatment. However, those between private coverage and public programs often fall into a “coverage gap.” This legislation aims to fix that.
Do you or someone in your family face challenges accessing Alzheimer’s treatment? Share your story or experience with health insurance in Illinois in the comments at ChicagoSuburbanFamily.com.
