How States Are Improving Access to Biomarker Testing

30 May How States Are Improving Access to Biomarker Testing

Posted at 08:00h in Advocacy, Finances, Health Insurance, Medical Care by Triage Cancer

What is Biomarker Testing?

Biomarker testing helps make sure that the treatment an individual receives is the right one for their cancer. Biomarkers are genes, proteins, or other substances that are in your blood, bodily fluids, or cells. They are also sometimes referred to as tumor markers.

There are many different names for biomarker testing including: genomic testing or profiling; tumor testing or subtyping; tumor genetic testing; somatic testing; and companion diagnostic testing.

Why is Biomarker Testing Important to Cancer Treatment?

Biomarkers may affect how certain cancer treatments will work. Understanding your biomarkers can help you and your health care team make treatment decisions that are best for you. This is often called personalized or precision medicine.

Biomarker testing is a key part of getting access to precision medicine. For example, some treatments may only work if you have certain biomarkers. Knowing your biomarkers can help you get treatment that is more likely to work for you, but also avoid treatment that likely won’t work for you.

What Does Biomarker Testing Cost?

The cost of biomarker testing depends on the type of test, the type of cancer, and health insurance coverage. There is not a federal requirement for health insurance companies to cover biomarker testing.

Many individuals have been denied coverage because even though they are useful in managing the overall cost of treatment, insurance companies claim they are not medically necessary.

Are Insurance Companies Required to Cover Biomarker Testing?

Some states have passed laws over the past few years to give patients access to biomarker testing.

Arizona, Illinois, Louisiana, and Rhode Island have laws that require broad insurance coverage of biomarker testing.

California and Washington have laws that prohibit insurance companies from requiring prior authorization for biomarker testing for individuals who have been diagnosed with advanced or metastatic cancer at stage 3 or 4.

In 2023, other state legislatures are working to expand access to biomarker testing. Arkansas, Georgia, Kentucky, Maryland, and New Mexico have all passed biomarker testing laws in 2023.

You can find more information about these state laws on coverage for biomarker testing on our Chart of State Laws: Biomarker Testing.

These states have pending legislation that would require health insurance companies to cover biomarker testing: California, Colorado, Connecticut, Florida, Maine, Massachusetts, Minnesota, Nevada, New York, Ohio, Oklahoma, Texas, and Washington.

Our State Policy and Legislative Advocacy: Current Issues Chart includes the status of each of these state bills and opportunities to advocate for coverage of the testing. You can find your state elected officials to ask them to support coverage for biomarker testing.

More Information and Resources

For more information about Biomarker Testing, read our Checklist to Understanding Biomarker Testing.

For more information about navigating health insurance, check out our Health Insurance Resources.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through events, materials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

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