Momentum is building for more state legislators to have health insurance companies pay for biomarker testing for patients with cancer. Kentucky recently became the latest state to pass legislation mandating payment, and Texas is considering two bills that would require biomarker testing coverage, including government-based plans such as Medicaid and the Children’s Health Insurance Program.
States Mandating Payment for Biomarker Testing
Besides Kentucky, legislators in other states have also enacted legislation regarding biomarking testing. Those states are (in order of passage):
- LouisianaSB 84. Signed into law – June 2021.
- Illinois HB 1779.Signed into law – July 2021.
- CaliforniaSB 912. Signed into law – October 2021. Vetoed by Governor Newsom September 2022.
- Washington HB1689. Signed into law – March 2022.
- ArizonaHB 2144 and SB1052. Signed into law – May 2022 and April 2023.
- Rhode Island H7587 and S2201. Signed into law – June 2022
- Massachusetts H1137. Signed into law – September 2022.
- Ohio Signed into law December – 2022.
- New Mexico Signed into law April – 2023.
- Arkansas HB1121. Signed into law April – 2023.
- Georgia Sent to Governor March 2023 for signage.
States besides Texas that are considering or have introduced similar legislation include Minnesota, New York, Colorado, Florida, Maine, Maryland, Nevada, and Pennsylvania.
What is Biomarker Testing?
Biomarker testing is a medical test that measures and identifies biomarkers in biological samples, such as blood, urine, or tissue. Biomarkers are specific molecules, such as proteins, DNA, or metabolites, that can indicate the presence or progression of a disease, the effectiveness of a treatment, or the risk of developing a disease. They are often used to diagnose diseases such as cancer, Alzheimer’s disease, or autoimmune disorders. Biomarker testing can also help guide treatment decisions by identifying which therapies will likely be most effective for a patient. For example, biomarker testing can identify patients who are likely to respond to a particular cancer therapy or who are at higher risk of side effects from a medication.
Biomarker Testing Costs and Other Challenges
The cost of biomarker testing is an ongoing concern for payers and providers.
According to a recent study of a US population of patients with metastatic lung or thyroid cancer, biomarker testing costs for payers ranged from a median of $128 (consumer-driven health plans) to $477 (preferred provider organizations).
Other challenges surrounding biomarker testing also put a strain on healthcare professionals, including insufficient or poor-quality tissue samples, technical errors, and delayed results. In a Genentech-sponsored study, almost 65 percent of potentially eligible patients did not receive personalized treatment because of challenges associated with integrating predictive biomarker testing into clinical care.
Precision Medicine and Biomarker Testing
The use of biomarker testing is likely to grow as precision (or personalized) medicine becomes more widely adopted. According to the American Cancer Society, researchers have developed many newer cancer treatments and biomarker tests in recent years, as they’ve come to better understand the different changes in genes, proteins, and other substances that can make cancer cells grow and spread.