Health Insurance State Laws:
Biomarker Testing

This chart highlights the state laws related to health insurance coverage of biomarker testing, including states that require coverage, and states with proposed legislation. Check back often, as this chart is updated frequently.

If you have a self-funded plan, certain state laws may not apply. For information on how to determine if your plan is self-funded, see our blog post.

If you don't find what you're looking for, see our other Charts of Health Insurance State Laws:

For more health insurance information, visit our Health Insurance Materials & Resources. If you are looking for information on Medicare or Medicaid, return to the main state laws page.

StateHas State Laws Requiring Insurance Coverage of Biomarker TestsState Law DescriptionType(s) of biomarker testing coveredSpecific population(s) to be testedTesting Purpose (e.g., screening, diagnosis, treatment, and/or monitoring)Entities covered by the law (e.g., health plans, employers, labs, etc)State Medicaid Program Required Coverage of Biomarker TestsState Laws that require insurance companies to cover laboratory tests to determine thelikelihood of response to specific cancer drugs.State Laws that require insurance companies to pay for FDA approved drugs if theyare listed in NCCN guidelines or the oncologist can provide two peer reviewedjournal articles to support the use of the drug in care.Pending State Legislation Addressing Insurance Coverage of Biomarker TestsOther Potentially Relevant State Laws for Biomarker Testing
ALABAMAXhttp://alisondb.legislature.state.al.us/alison/codeofalabama/1975/27-1-10.1.htmXhttp://alisondb.legislature.state.al.us/alison/codeofalabama/1975/27-1-10.1.htmRequires health insurance companies cover tests which may overlap with biomarker testing: mammograms; colorectal cancer exams and lab tests; and pancreatic cancer screening for men over 40.http://alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-50-4.htm
ALASKAXAlaska | Genetics Policy HubHealth insurers must cover colorectal cancer screening for individuals over 50, annual prostate screenings, low-dose mammography screening, and cancer-related clinical trial expenses.https://www.akleg.gov/basis/Bill/Text/23?Hsid=HB0195B
ARIZONAAZ Rev Stat § 20-1406.10 (2022)https://www.azleg.gov/legtext/55leg/2R/bills/HB2144H.htmThe law provides for coverage of biomarker testing from hospital and medical service corporations, health care service organizations, disability insurers, group/blanket disability insurers, and the Arizona Health Care Cost Containment System (AHCCCS). Biomarker testing is covered for purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an insured's disease or condition to guide treatment as long as the test provides clinical utility as demonstrated by medical and scientific evidence (such as FDA-labeled tests, CMS national coverage determinations, nationally-recognized clinical practice guidelines).The analysis of issue, blood, or other biospecimen of a biomarker. Includes single-analyte tests, multiplex panel tests, and whole genome sequencing.Diagnosis, treatment, appropriate management, or ongoing monitoring of an individual’s disease or condition to guide treatment decisions.A hospital service corporation or medical service corporation that issues, amends, delivers, or renews a subscription contract on or after January 1, 2023, shall provide coverage for biomarker testing.A hospital service corporation or medical service corporation must ensure that coverage is provided in a manner that limits disruption in care, including the need for multiple biopsies or biospecimen samples.Xhttps://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/36/02907-03.htmXhttps://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/20/00841-13.htmXhttps://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/20/00841-13.htmA healthcare organization is only responsible for covering patient costs related to a voluntary participation in an AZ cancer clinical trial. Additionally, a contract providing coverage for mastectomy surgical services must also cover diagnostic mammography screenings on dedicated equipment when referred by a physicianhttps://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/20/01057-07.htm
ARKANSASArkansas HB 1121 was signed into law on 4/4/2023 as Act 429https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2023R%2FPublic%2FACT429.pdfHealth insurance policies are required to provide coverage of biomarker testing for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of a subscriber's disease or condition to guide treatment decisions when the biomarker test is supported by medical and scientific evidenceRequires plans to cover biomarker testing for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of a disease or condition to guide treatment decisions.individual, blanket, or group plan, policy, or contract for healthcare services issued, renewed, or extended in this state by a healthcare insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church planX https://law.justia.com/codes/arkansas/2017/title-23/subtitle-3/chapter-99/subchapter-11/section-23-99-1114/X https://law.justia.com/codes/arkansas/2019/title-23/subtitle-3/chapter-79/subchapter-1/section-23-79-147/“Specified Disease Coverage” pays benefits for the diagnosis and treatment of a specifically named disease or diseases. Additionally, screening is covered for prostate cancer in men 40+
CALIFORNIACal. Health & Safety Code 1367.667https://legiscan.com/CA/text/SB496/2023Requires health insurance coverage for medically necessary biomarker testing, subject to utilization review management.Biomarker testing includes, but is not limited to, single-analyte tests, multiplex panel tests, and whole genome sequencingDiagnosis, treatment, appropriate management, or ongoing monitoring of an individual’s disease or condition to guide treatment decisionsA health insurance policy that is issued, amended, delivered, or renewed on or after July 1, 2024"Medical and scientific evidence" in the legislation refers to any of the following:1) A test with an approved or cleared label by the FDA or an indicated test for an FDA-approved drug; 2) A national coverage determination by the Centers for Medicare and Medicaid Services or a local coverage determination by a Medicare Administrative Contractor; and 3) Widely recognized clinical practice guidelines and consensus statements.X https://1.next.westlaw.com/Document/I82D699C0AB5711ED81C18076A89109CB/View/FullText.html?originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&firstPage=true&bhcp=1X https://1.next.westlaw.com/Document/I82D699C0AB5711ED81C18076A89109CB/View/FullText.html?originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&firstPage=true&bhcp=1Xhttps://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=INS&division=2.&title=&part=2.&chapter=1.&article=1.
COLORADOXhttps://leg.colorado.gov/sites/default/files/documents/2022A/bills/2022a_1264_rer.pdfHouse Bill 1110 would require all individual and group health benefit plans, as well as the state medical assistance program, to provide coverage for biomarker testing if the testing is supported by medical and scientific evidence.https://leg.colorado.gov/bills/hb23-1110Under the Colorado Medical Assistance rules, all female and transgender Medicaid patients are eligible to receive “women’s health services,” which include BRCA screening, genetic counseling, and testing. Such requirement is limited to BRCA testing anddoes not extend to biomarker testing more broadly.https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=8091&fileName=10%20CCR%202505-10%208.700
CONNECTICUTXServices covered and limitations, Conn. Agencies Regs. § 17b-262-645 | Casetext Search + Citatorent-of-laboratory-services/section-17b-262-645-services-covered-and-limitationsHouse Bill 6628 would mandate Medicaid coverage for biomarker testing to diagnose, treat, manage, or monitor a Medicaid enrollee's disease or condition, within federal law limitations. 2) Connecticut House Bill 976, introduced on February 8, 2023, proposes specific health insurance coverage requirements for individual and group policies in Connecticut.https://legiscan.com/CT/text/HB06628/id/2689292
DELAWAREDel. Code Ann. tit. 18, § 3338(a) and Del. Code Ann. tit. 18, § 3555(a)https://legis.delaware.gov/SessionLaws/Chapter?id=21313Requires coverage for mandatory coverage of CA-125 (a biomarker) monitoring of ovarian cancer subsequent to treatment.Monitoring1) Del. Code Ann. tit. 18, § 3338(a) applies to every individual health, sickness or accident insurance policy from any health insurer that provides benefits for outpatient services. 2) Del. Code Ann. tit. 18, § 3555(a) applies to all group and blanket health insurance policies which provide benefits for outpatient services.X
FLORIDAH.B. 1218 would require AHCA to pay for biomarker testing under Florida Medicaid and would mandate managed care plans and various health insurance policies and contracts to provide coverage for biomarker testing.https://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=76864Requires health insurance companies to provide coverage for the following categories of care that may overlap with biomarker testing including coverage of mammograms for women 35 years and older.http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.6418.html#:~:text=(1)%20An%20accident%20or%20health,than%2040%20years%20of%20age
GEORGIAAct 232 (amending Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated and Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated)https://www.legis.ga.gov/legislation/63669Effective July 1, 2023, health benefits policies and Medicaid, shall include coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the testing is supported by medical and scientific evidence.Includes, but is not limited to, single-analyte tests, multiplex panel tests, whole genome sequencing, protein expression, whole exome, and whole transcriptome.Diagnosis, treatment, appropriate management, or ongoing monitoring of a disease or condition.Any individual or group plan, policy, or contract for healthcare services issued, delivered, issued for delivery, or renewed in this state after July 1, 2023XCoverage for: survaliance for women 35+ at risk of ovarian cancer; colorectal cancer screening; coverage of children enrolled in cancer-related clinical trials; OBGYN services; coverage of off label drug use.https://law.justia.com/codes/georgia/2020/title-33/chapter-24/article-1/section-33-24-56-2/
HAWAIIXhttps://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0321/HRS_0321-0045.htmCoverage for low-dose mammography deemed medically necessaryhttps://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0116.htm
IDAHOPlans that cover mastectomys must cover minimum mammography examination or equivalent examination coverage.https://legislature.idaho.gov/statutesrules/idstat/title41/t41ch41/sect41-4125/
ILLINOISPublic Act 102-0203 (to be codified at 215 ILCS 5/356z.43).https://www.ilga.gov/legislation/fulltext.asp?DocName=&SessionId=110&GA=102&DocTypeId=HB&DocNum=1779&GAID=16&LegID=130484&SpecSess=&Session=The law requires health insurance plans amended, delivered, issued, or renewed after January 1, 2022, to include coverage for biomarker testing for purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the test is supported by medical and scientific evidence (such as FDA labeling, CMS national coverage determination, nationally recognized clinical practice guidelines, etc.). Coverage and testing shall be conducted in an efficient manner to provide the most complete range of results to the healthcare provider without requiring multiple biopsies, biospecimen samples, or other delays or disruptions in patient care. Law also provides that where biomarker testing is restricted by an insurance plan that there shall be a clear and accessible process to request an exception on the insurer's website.Includes, but is not limited to, singleanalyte tests, multi-plex panel tests, and partial or whole genome sequencing.Diagnosis, treatment, appropriate management, or ongoing monitoring of a disease or conditionA group or individual policy or accident and health insurance or managed care plan amended, delivered, issued or renewed on or after January 1, 2022, shall include coverage for biomarker testing.XIllinois General Assembly - Full Text of Public Act 102-020X215 ILCS 5/ Illinois Insurance Code.X215 ILCS 5/ Illinois Insurance Code.Requires coverage for the following categories of care which may overlap with biomarker testing: mamography; annual PAP smear; genetic testing for breast and ovarian cancer; colorectal cancer exams; pancreatic cancer screening; and colonoscopy coverage.https://www.ilga.gov/legislation/ilcs/documents/021500050k356g.htm https://www.ilga.gov/legislation/ilcs/documents/021500050K356u.htm https://www.ilga.gov/legislation/ilcs/documents/021500050K356x.htmhttps://ilga.gov/legislation/ilcs/documents/021500050K356z.47.htmhttps://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=021500050K356z.48
INDIANA
IOWASince July 1, 2013, the CPT Code 86352 “CELLULAR FUNC ASSAY, DETECT OF BIOMRKER” has been covered under the Iowa Medicaid physician fee schedules for MDs and DOs.https://secureapp.dhs.state.ia.us/MedicaidFeeSched/X02.xmlX514C.24 Cancer treatment — coverage.https://www.legis.iowa.gov/docs/code/514C.26.pdf
KANSASX https://www.ksrevisor.org/statutes/chapters/ch40/040_002_0184.html https://www.ksrevisor.org/statutes/chapters/ch40/040_002_0168.html
KENTUCKYChapter 77 amends Kentucky Revised Statutes Chapter 304, Section 17-A, New Subsectionhttps://apps.legislature.ky.gov/record/23rs/hb180.htmlCreate a new section of Subtitle 17A of KRS Chapter 304 to establish biomarker testing coverage requirements for health benefit plans; amend KRS 205.522 to require Medicaid to comply with the biomarker testing coverage requirements; direct that provisions apply to health benefit plans issued or renewed on or after January 1, 2024;X https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=43957House Bill 180 would require biomarker testing coverage by health benefit plans and Medicaid.https://apps.legislature.ky.gov/recorddocuments/bill/23RS/hb180/bill.pdfCoverage for any genetic test for cancer risk and coverage for cancer clinical trials.https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49487
LOUISIANALouisiana Rev. Stat. 22:1028.3.https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1308205Any health coverage plan renewed, delivered, or issued for delivery in Louisiana shall include coverage, subject to deductibles, coinsurance, and copayment, for genetic or molecular testing for cancer including but not limited to tumor mutation testing, next generation sequencing, hereditary germline mutation testing, pharmacogenomic testing, whole exome and genome sequencing, and biomarker testing. Act No. 412 (amending Louisiana Rev. Stat. 22:1028.3): This act will take effect on January 1, 2023. It clarifies that the biomarker test shall be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an individual's disease or condition when the test is supported by medical and scientific evidence.Biomarker testing includes but is not limited to single-analyte tests, multi-plex panel tests, and partial or whole genome, whole exome, and whole transcriptome sequencing.The biomarker test shall be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an individual’s disease or condition when the test is supported by medical and scientific evidenceAny health coverage plan renewed, delivered, or issued for delivery in this state shall include coverage for ... biomarker testingXhttp://legis.la.gov/legis/Law.aspx?d=1148103 http://legis.la.gov/legis/Law.aspx?d=1240069 http://legis.la.gov/legis/Law.aspx?d=507869 http://legis.la.gov/legis/Law.aspx?d=1108752Xhttp://legis.la.gov/legis/Law.aspx?d=507868
MAINEXhttps://legislature.maine.gov/statutes/24-A/title24-Asec4234-D.htmlOn April 10, 2023, the State senate passed SB805 which requires the Maine Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage for biomarker testing that is supported by medical and scientific evidence. The Bill also establishes requirements for deductibles, copayments, coinsurance, and utilization review for biomarker testing. The Bill is awaiting the governor’s signature.https://www.maine.gov/dhhs/blog/mainecare-implements-new-rate-reforms-supported-current-services-budget-2023-06-27Requires coverage for the following categories of care which may overlap with biomarker testing: prostate cancer exams; breast cancer screenings; colorectal cancer screenings; required annual preventive care coverage; and coverage for low-dose mammography screening.https://legislature.maine.gov/legis/statutes/24-A/title24-Asec2847-N.html
MARYLANDChapter 322 Annotated Code of Maryland Article – Health – General Sections 15–102.3(k), 103(a)https://mgaleg.maryland.gov/2023RS/Chapters_noln/CH_322_sb0805e.pdfEffective July 1, 2025, health insurance plans shall provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the testing is supported by medical and scientific evidence.Xhttps://mgaleg.maryland.gov/mgawebsite/Legislation/Details/hb1217?ys=2023RS#:~:text=Requiring%20the%20Maryland%20Medical%20Assistance,establishing%20requirements%20for%20deductibles%2C%20copayments%2CXhttps://law.justia.com/codes/maryland/2020/insurance/title-15/subtitle-8/section-15-827/On April 10, 2023, the State senate passed SB805 which requires the Maryland Medical Assistance Program and certain insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations to provide coverage for biomarker testing that is supported by medical and scientific evidence. The Bill also establishes requirements for deductibles, copayments, coinsurance, and utilization review for biomarker testing. The Bill is awaiting the governor’s signature.https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0805?ys=2023RSRequires coverage for the following categories of care which may overlap with biomarker testing: prostate cancer exams; breast cancer screenings; colorectal cancer screenings; required annual preventive care coverage; and coverage for low-dose mammography screening.https://law.justia.com/codes/maryland/2022/insurance/title-15/subtitle-8/
MASSACHUSETTSXhttps://1.next.westlaw.com/Document/IE61C56F218A911ED936B88C7645095E4/View/FullText.html?transitionType=Default&contextData=(oc.Default) https://1.next.westlaw.com/Document/IE61C56F218A911ED936B88C7645095E4/View/FullText.html?transitionType=Default&contextData=(oc.Default)HB 1074/S. 689 would require coverage of biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition when the test is supported by medical and scientific evidencehttps://malegislature.gov/Bills/193/S689
MICHIGAN https://www.michigan.gov/mdhhs/keep-mi-healthy/chronicdiseases/cancer/bc3npRequires coverage for breast cancer diagnostic services, outpatient treatment services, and rehabilitative services.https://law.justia.com/codes/michigan/2006/mcl-chap500/mcl-500-3406d.html
MINNESOTAMinn. Stat. § 62Q.473Added by 2023 Minn. Laws, ch. 70,s 2-26, eff. 1/1/2025https://www.revisor.mn.gov/laws/2023/0/70/laws.2.26.0#laws.2.26.0Effective January 1, 2025, health insurance plans shall provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the testing is supported by medical and scientific evidence.House Bill HF 4899 would require health plans to provide coverage for biomarker testinghttps://www.revisor.mn.gov/bills/bill.php?b=House&f=HF4899&ssn=0&y=2021Requires coverage of routine screening procedures for cancer.https://www.revisor.mn.gov/statutes/cite/62a.30#:~:text=Every%20policy%2C%20plan%2C%20certificate%2C,are%20at%20risk%20for%20ovarian
MISSISSIPPIX
MISSOURIhttps://health.mo.gov/living/healthcondiseases/chronic/showmehealthywomen/index.phpRequires coverage for breast cancer diagnostic services, outpatient treatment services, and rehabilitative services.https://revisor.mo.gov/main/OneSection.aspx?section=376.1200
MONTANA
NEBRASKAX https://nebraskalegislature.gov/laws/statutes.php?statute=44-788Requires coverage of: treatment for breast or cervical cancer for those meeting certain eligibility criteria for Medicaid; colorectal cancer screenings and exams; and coverage for mammography screening.https://nebraskalegislature.gov/laws/browse-chapters.php?chapter=44
NEVADANRS 287.010, 287.04335, 422.2717-422.27248, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1655-689C.169, 689C.194-689C.195, 689C.425, 695A.184-695A.1875, 695B.1901-695B.1949, 695C.050, 695C.1691-695C.176, 695G.162-695G.177https://www.leg.state.nv.us/App/NELIS/REL/82nd2023/Bill/9818/Text#Requires health insurance plans to provide coverage for biomarker testing when it is cost effective and medically necessary to improve health. Parts effective 6/13/2023, 7/1/2023, and 10/1/2023XNRS: CHAPTER 695C - HEALTH MAINTENANCE ORGANIZATIONSAssembly Bill No. 155 would establish a Task Force on Precision Medicine and Biomarker Testing and require health insurance policies to include coverage of biomarker testing in certain circumstances.https://www.leg.state.nv.us/App/NELIS/REL/82nd2023/Bill/9818/Text
NEW HAMPSHIREhttps://legiscan.com/NH/bill/HB323/2023
NEW JERSEY
NEW MEXICONMS § 13-7-NEWAdded by 2023, c. 138,s. 1, eff. 6/13/2023https://www.nmlegis.gov/Sessions/23%20Regular/final/HB0073.pdfEffective January 1, 2024, biomarker testing is covered for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of an insured's disease or condition when the test is supported by medical and scientific evidence.
NEW YORKSenate Bill S1196Ahttps://www.nysenate.gov/legislation/bills/2023/S1196/amendment/AEffective April 1, 2024, requires health insurance policies to cover biomarker testing for diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when the test is supported by medical and scientific evidenceDiagnosis, treatment, appropriate management, or ongoing monitoringEvery individual accident and health insurance policy that provides coverage for medical, major medical, or similar comprehensive-type coverage; group or blanket accident and health insurance policies; all hospital service corporation or health service corportion; and Medicaidxhttps://www.nysenate.gov/node/12013563
NORTH CAROLINAXhttps://www.ncleg.net/enactedlegislation/statutes/pdf/byarticle/chapter_58/article_67.pdf
NORTH DAKOTAhttps://medicaid.ncdhhs.gov/blog/2020/09/15/coverage-genetic-testing-breast-cancer
OHIOHB608 would require health plans and Medicaid to cover biomarker testing including but not limited to the analysis of tissue, blood, or another biospecimen for the presence of a biomarker, and includes, but is not limited to, single-analyte tests, multiplex panel tests, and whole genome sequencing.https://www.legislature.ohio.gov/legislation/134/hb608Requires coverage of routine patient care during a cancer clinical trial; breast and cervical cancer screenings; and orally administered cancer medications. Prohibits “fail first” coverage of drugs used to treat certain cancer.https://codes.ohio.gov/ohio-revised-code/section-1751.69
OKLAHOMAOkla. Stat. tit. 56, § 4003Added by Laws 2023, c. 331,s. 3, eff. 1/1/2024.http://webserver1.lsb.state.ok.us/cf_pdf/2023-24%20ENR/SB/SB513%20ENR.PDFProvides coverage for biomarker testing for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of an insured’s disease or condition to guide treatment decisions when the biomarker test provides clinical utility as demonstrated by medical and scientific evidence.Testing for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of an insured’s disease or condition to guide treatment decisionsAny health benefit plan, including the Oklahoma EmployeesInsurance Plan issued or renewed after Jan. 1, 2024X
OREGONX
PENNSYLVANIAX
RHODE ISLANDRI Stat. 27-18-89http://webserver.rilin.state.ri.us/BillText/BillText22/SenateText22/S2201A.pdfEffective January 1, 2024. Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy in Rhode Island shall provide coverage for the services of biomarker testing under each health insurer's respective principles and mechanisms of reimbursement, credentialing, and contracting. Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition to guide treatment decisions, and only when the test provides clinical utility as demonstrated by medical and scientific evidence.Biomarker testing includes but is not limited to single-analyte tests, multi-plex panel tests, and partial or whole genome, whole exome, and whole transcriptome sequencing.Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition to guide treatment decisions, when the test provides clinical utility as demonstrated by medical and scientific evidenceEvery individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2024, shall provide coverage for the services of biomarker testing in accordance with each health insurer’s respective principles and mechanisms of reimbursement, credentialing, and contractingFor Medicaid patientss, requests for biomarker testing that is the subject of a clinical trial or experimental protocol will be denied. Prior authorization is required.XXX
SOUTH CAROLINAX
SOUTH DAKOTA
TENNESSEE
TEXASSECTIONA1. AASubtitle E, Title 8, Insurance Code, is amendedby adding Chapter 1372 to read as follows:CHAPTER 1372. COVERAGE FOR BIOMARKER TESTINGSec.A1372.001.Ahttps://capitol.texas.gov/tlodocs/88R/billtext/pdf/SB00989F.pdf#navpanes=0Effective 9/1/2023 Health Insurance Plans are required health benefit plan must provide coverage for biomarker testing for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition to guide treatment when the test is supported by medical and scientific evidenceArguably, under a (very) broad reading of Tex. Ins. Code Ann. § 1369.004(b) – Coverage of a drug required under Subsection (a) [infra] must include coverage of medically necessary services associated with the administration of the drug.XSenate Bill 989, would require coverage for biomarker testing for the purpose of diagnosis, treatment,appropriate management, or ongoing monitoring of an enrollee's disease or condition to guide treatmenthttps://capitol.texas.gov/tlodocs/88R/billtext/html/SB00989I.htmRequires coverage for the following categories of care which may overlap with biomarker testing: Annual low-dose mammography for all women 35 years of age or older; colorectal cancer examinations and laboratory tests for colorectal cancer; and physical exam for prostrate cancer and PSA antigen test for males above 50 years of age or over 40 years of age with family history.https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1370.htm
UTAH
VERMONTRequires coverage for prostate and colorectal cancer screeningshttps://legislature.vermont.gov/statutes/section/08/107/04100g
VIRGINIAX
WASHINGTONRCW 48.43.810https://app.leg.wa.gov/RCW/default.aspx?cite=48.43.810Law requires health plans issued or renewed on or after January 1, 2023, to exempt enrollees from prior authorization requirements for coverage of biomarker testing for either: (1) stage 3 or 4 cancer, or (2) recurrent, relapsed, refractory, or metastatic cancer. The testing must be a covered service, recommended in nationally recognized guidelines or biomarker compendia, approved by the FDA or otherwise validated, and be prescribed by an in-network provider.Single or multigene diagnostic test of the cancer patient's biospecimen, such as tissue, blood, or other bodily fluids, for DNA, RNA, or protein alterations, including phenotypic characteristics of a malignancy, to identify an individual with a subtype of cancer, in order to guide patient treatment.Individuals with cancerEffective June 9, 2022, health plans issued or renewed on or after January 1, 2023 must exempt an enrollee from prior authorization requirements for coverage of biomarker testing for either (a) stage 3 or 4 cancer, or (b) recurrent, relapsed, refractory, or metastatic cancer.Biomarker testing must be (a) recommended in the latest version of nationally recognized guidelines or biomarker compendia, such as those published by the national comprehensive cancer network, (b) approved by the FDA or a validated clinical laboratory test performed in a clinical laboratory certified under the clinical laboratory improvement amendments or in an alternative laboratory program approved by CMS, (c) a covered service, and (d) prescribed by an in-network provider.XXSubstitute House Bill 1450 would reqire coverage of biomarker testing for the purposes ofdiagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's stage 1, 2, 3, or 4 cancer or brain cancerhttps://app.leg.wa.gov/billsummary?BillNumber=1450&Year=2023&Initiative=false
WEST VIRGINIAXRequires coverage for the following categories of care which may overlap with biomarker testing: Colorectal cancer examinations and laboratory tests; mammograms when medically appropriate; pap smears; and HPV tests for women 18 years and older when medically approproate.https://code.wvlegislature.gov/33-15-4C/
WISCONSIN
WYOMING
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