The bill requires all individual and group health benefit plans to provide coverage for biomarker testing if the testing is supported by medical and scientific evidence. Biomarker testing is defined 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 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, 2025.
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.
If a carrier requires prior authorization for biomarker testing, the bill requires the carrier to use an expedited prior authorization process.
Subject to federal authorization and federal financial participation, beginning July 1, 2024, the bill includes coverage for biomarker testing as part of the state medical assistance program if the testing is supported by medical and scientific evidence.
Under the state medical assistance program, the bill requires an expedited utilization review and prior authorization process, as well as an appeal process if biomarker testing is denied.
(Note: This summary applies to this bill as introduced.)