Health-Care Coverage for Biomarker Testing
The bill requires all individual and group health benefit plans to provide coverage for biomarker testing to guide treatment decisions if the testing is supported by medical and scientific evidence. The bill defines "biomarker testing" as an analysis of a patient's tissue, blood, or other biospecimen for the presence of an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. The required testing under the bill does not include biomarker testing for screening purposes or direct-to-consumer genetic tests.
The bill requires the commissioner of insurance to implement biomarker testing coverage for all individual and group health benefit plans issued or renewed on or after January 1, 2026.
Biomarker testing is subject to the health benefit plan's annual deductibles, copayment, or coinsurance but is not subject to any annual or lifetime maximum benefit limit.
Subject to federal authorization and federal financial participation, beginning July 1, 2025, the bill includes coverage for biomarker testing as part of the state medical assistance program to guide treatment decisions if the testing is supported by medical and scientific evidence.
The bill requires the medical assistance program to have a clear, easily accessible appeals process if biomarker testing is denied.
(Note: This summary applies to this bill as introduced.)