Arkansas committee advances bill to require state plan coverage for new Alzheimer’s treatments

Representative Julie Mayberry introduced House Bill 1055, which would require the state employee and public school insurance plans administered by the Employee Benefits Division (EBD) to cover Alzheimer’s disease therapies that have been approved by the U.S. Food and Drug Administration.

The measure, presented as an access bill for state employees and public school staff, drew testimony from clinicians, the Alzheimer’s Association and patients’ family members. “This decision…should happen in clinicians’ offices by physicians and not be principally denied by bureaucrats,” said David Cook, director of government affairs for the Alzheimer’s Association, urging parity with Medicare, Medicaid and the U.S. Department of Veterans Affairs coverage.

The bill’s proponents said the new class of drugs — approved in 2023 and aimed at disease biology rather than behavioral symptoms — is indicated only for carefully selected patients in very early stages of disease. “These medications have undergone rigorous testing,” said Dr. Morgan Sauer of Baptist Health and UAMS. “They are not easy to take … they’re IV infusions, and there is a rigorous process to be sure these medications are being used appropriately.” She described eligibility criteria (mild cognitive impairment or mild Alzheimer’s disease, specialized imaging or spinal‑fluid testing to demonstrate amyloid pathology) and said treatment is stopped if a patient progresses to moderate or severe disease.

Family members and patients gave personal testimony. Lori Case Melton described her husband’s early‑onset diagnosis and multiple denials from a drug‑company assistance program she said required a household income below a cutoff; retired educator Steve Daniels said he had received infusions and reported improved clarity after treatment.

Grant Wallace, director of the Employee Benefits Division, told the committee the office balances access against a fiduciary duty to plan participants and that EBD’s fiscal estimate for the bill ranged from $2 million to $4 million. Wallace said the division projects a substantial per‑patient medication and monitoring cost — citing estimates that include drug, imaging and increased monitoring that together have been discussed in analysis as producing higher per‑patient totals — and warned that the bill would limit EBD’s ability to use utilization management and to review treatments on a clinical‑evidence timetable. "This is the toughest part of my job… I have to look at the dollars and cents," Wallace said.

Advocates disputed the high‑end cost projection and presented utilization and prevalence data to argue the eligible population under state plans would be very small. Cook cited Mayo Clinic prevalence figures and state plan enrollment data and said the Alzheimer’s Association’s analysis estimated roughly 29 eligible people in one state plan pool under conservative assumptions; he also referenced a comparison to Indiana Medicaid claims where only 8 enrollees qualified in 2023. Proponents asked the committee to balance that small eligible population against more difficult and costly late‑stage care that could follow delayed treatment.

Members asked about guardrails to prevent broad or inappropriate prescribing. Proponents said plans that already cover the drugs generally follow Medicare criteria, require specialist prescribers (neurologists, geriatricians, behavioral neurologists), specialized imaging or cerebrospinal fluid testing, enrollment in national registries and post‑market monitoring to confirm benefit. Mayberry said the bill allows EBD to require prior authorization procedures so long as they are not more restrictive than the FDA label and supporting guidance.

Committee members also probed access limitations inside Arkansas: Sauer and others said few in‑state centers currently offer the specialized imaging and infusion services, requiring travel for many patients; proponents urged expansion of testing and treatment capacity. Questions about out‑of‑pocket drug costs elicited testimony that negotiated cash prices and patient assistance programs vary; witnesses said some families face large monthly costs without insurance support.

After questions and additional public testimony, a member moved to pass the bill and the committee approved it by voice vote.

The measure advances with an acknowledgment in the record that fiscal estimates differ: EBD’s projected $2–$4 million impact versus proponents’ contention that the eligible population — and therefore costs — will be much smaller. The bill also preserves EBD’s authority to apply prior authorization and utilization review so long as those requirements are not more restrictive than the FDA label and clinical guidance, according to proponents’ description of the text.