I bear in mind a affected person in her early sixties who got here to our clinic with refined reminiscence issues. She lived alone in a rural county, relied on Medicaid, and had been handed between social companies and totally different major care suppliers for greater than a 12 months. Nobody had ordered imaging, and there have been no neurologists close by. By the point Alzheimer’s illness was suspected, her window for early intervention had already closed.
Medicare just lately expanded protection for amyloid PET scans, giving extra sufferers a path to earlier analysis. However for the thousands and thousands of individuals lined by Medicaid, particularly these at highest threat, entry to even probably the most primary diagnostic instruments stays restricted. Blood-based biomarker exams are actually clinically validated and more and more accessible, but most Medicaid applications haven’t up to date their protection to replicate this shift. That coverage hole delays analysis and narrows therapy choices.
Plasma biomarkers such because the Aβ42/40 ratio, phosphorylated tau (p-tau181), glial fibrillary acidic protein (GFAP), and neurofilament mild chain (NfL) can detect early modifications in Alzheimer’s illness with a excessive diploma of accuracy. These exams are much less invasive than spinal fluid evaluation, extra inexpensive than PET imaging, and simpler to make use of in major care settings. They’ve grow to be much more essential with the emergence of latest disease-modifying therapies like lecanemab and donanemab, each of which require biomarker affirmation earlier than use.
In Could 2025, the FDA cleared the primary Alzheimer’s blood take a look at by way of the substantial equivalence pathway, recognizing it as corresponding to present diagnostic strategies. Regardless of this milestone, most Medicaid applications haven’t included these exams into their protection frameworks. A overview of all 51 state Medicaid applications discovered that solely 18 point out Alzheimer’s blood exams of their public protection paperwork. Fewer than half embody billing codes, and only a few acknowledge the entry obstacles confronted by medically underserved sufferers. In the meantime, PET scans and spinal fluid exams are nonetheless lined in most states, despite the fact that they’re typically dearer and fewer accessible, notably in rural areas.
This disconnect reinforces long-standing disparities in care. Black and Hispanic adults usually tend to be insured by way of Medicaid, extra prone to develop Alzheimer’s, and extra prone to expertise delayed analysis. When lower-cost, clinically applicable diagnostics are excluded from protection, these inequities develop even deeper.
Some states have began to take steps. In 2024, Florida handed laws requiring Medicaid to cowl Alzheimer’s blood exams. Whereas implementation will differ throughout care settings, the scientific rationale is obvious. Nonetheless, with out federal steerage, most states haven’t acted. Diagnostic entry now relies upon much less on medical want and extra on location.
To shut the hole, the Facilities for Medicare & Medicaid Companies ought to problem formal steerage supporting protection of FDA-cleared blood-based diagnostics. States can then set up constant billing practices and implementation methods that prioritize entry from the start fairly than ready till disparities emerge.
We have already got the instruments to establish Alzheimer’s earlier, extra affordably, and in a means that reduces the burden on each sufferers and suppliers. The actual impediment will not be expertise, it’s coverage. Clinicians and caregivers proceed to see the consequences of delayed analysis, particularly in communities with restricted entry to specialty care. Medicaid applications have a chance to deal with this downside straight. Sufferers shouldn’t be denied well timed analysis just because their insurance coverage hasn’t saved up with the science.
Amanda Matter is a physician of pharmacy scholar.
