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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.

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StateState Law Requiring Insurance Coverage of Biomarker TestingState Law DescriptionProposed Legislation Requiring Insurance Coverage of Biomarker TestingProposed Legislation Description
ALABAMA
ALASKA
ARIZONAAriz. HB 2144. Bill signed into law May 6, 2022; law in effect and will be statutorily codified January 1, 2023.The law will provide 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 will be 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).https://www.azleg.gov/legtext/55leg/2R/laws/0219.htm
ARKANSAS
CALIFORNIACalif. Ins. Code 10123.20.Health insurance policies issued, amended, delivered, or renewed after July 1, 2022, cannot require prior authorization for biomarker testing for: (1) individuals with advanced or metastatic stage 3 or 4 cancer; or (2) cancer progression or recurrence in an individual with advanced or metastatic stage 3 or 4 cancer. It does not cover biomarker testing that is not for an FDA-approved therapy for advanced or metastatic stage 3 or 4 cancer.https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS§ionNum=10123.20.&article=1.&highlight=true&keyword=biomarkerCalifornia SB 912Governor Gavin Newsom vetoed the bill on September 29, 2022. Consideration of the Governor's veto is pending in the Senate. Bill would have provided coverage for biomarker testing (includes whole genome sequencing) for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an individual's disease or condition if the test is supported by medical and scientific evidence, as prescribed. Bill would have required insurance coverage in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples.https://leginfo.legislature.ca.gov/faces/billPdf.xhtml?bill_id=202120220SB912&version=20210SB91298AMD
COLORADO
CONNECTICUT
DELAWARE
*DISTRICT OF COLUMBIA
FLORIDA
GEORGIAHR 998 & SR 777No proposed legislation related to biomarker insurance coverage in Georgia. However, in spring 2022, the House and Senate passed resolutions recognizing the benefits of biomarker testing as a necessary part of precision medicine.https://www.legis.ga.gov/legislation/62794; https://www.legis.ga.gov/legislation/63036
HAWAII
IDAHO
ILLINOISPublic Act 102-0203 (to be codified at 215 ILCS 5/356z.43).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.https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=102-0203
INDIANA
IOWAHR 6. No proposed legislation related to biomarker insurance coverage in Iowa. However, in 2022 HR 6 declared March as "Precision Medicine and Biomarker Testing Awareness Month."https://www.legis.iowa.gov/legislation/BillBook?ga=89&ba=HR%206
KANSAS
KENTUCKY
LOUISIANALouisiana Rev. Stat. 22:1028.3. Act No. 412 (amending Louisiana Rev. Stat. 22:1028.3). Rev. Stat. 22:1028.3: Any 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.http://www.legis.la.gov/legis/Law.aspx?d=1240069
MAINE
MARYLAND
MASSACHUSETTSH. 1137On September 15, 2022, the House ordered the Joint Committee on Health Care Financing to study the bill and report back its findings by December 31, 2022. Bill would provide that insurers could not require prior authorization for biomarker testing for an individual with advanced or metastatic stage 3 or 4 cancer, including testing for cancer progression or recurrence. A matching Senate bill (S.808) is also under review by the committee on Health Care Financing.https://malegislature.gov/Bills/192/H1137.pdf
MICHIGAN
MINNESOTAH 1137On September 15, 2022, the House ordered the Joint Committee on Health Care Financing to study the bill and report back its findings by December 31, 2022. Bill would provide that insurers could not require prior authorization for biomarker testing for an individual with advanced or metastatic stage 3 or 4 cancer, including testing for cancer progression or recurrence. A matching Senate bill (S.808) is also under review by the committee on Health Care Financing. https://www.revisor.mn.gov/bills/text.php?number=SF4610&version=latest&session=ls92&session_year=2022&session_number=0
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIREHB 1290.New Hampshire has not yet proposed legislation related to insurance coverage of biomarker testing, however the state did try to establish a task force on precision medicine, including biomarkers.https://www.gencourt.state.nh.us/bill_status/billinfo.aspx?id=1770&inflect=2
NEW JERSEY
NEW MEXICO
NEW YORKSB8147/A9149 Proposed legislation still in committee, labeled active as of October 24, 2022, though the 2022 New York Legislative session is over. Bill would require insurance policies to cover biomarker testing for the purpose 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. https://legislation.nysenate.gov/pdf/bills/2021/S8147
NORTH CAROLINA
NORTH DAKOTA
OHIOHB 608As of October 20, 2022, Bill is currently in committee and Ohio legislative session is not yet over. Bill would require biomarker testing to be covered for diagnosis, treatment and appropriate management of a disease or condition, or ongoing monitoring. The biomarker test must be supported by medical and scientific evidence. The bill would require insurance coverage in a manner that limits disruption of care.https://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_134/bills/hb608/RCH/02/hb608_02_RCH?format=pdf
OKLAHOMA
OREGON
PENNSYLVANIA
*PUERTO RICO
RHODE ISLANDRI H7587Law passed 6/27/2022 (to be codified at RI Stat. 27-18-89); provisions in effect on 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.http://webserver.rilin.state.ri.us/PublicLaws/law22/law22152.htm
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTONRev. Code Wash 48.43.XX (to be codified); Session Law Chapter 123, Laws of 2022 Engrossed Substitute HB 1689 coverage effective January 1, 2023.Coverage effective January 1, 2023. Law 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.https://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Session%20Laws/House/1689-S.SL.pdf?q=20220701105926SB 5822Introduced in January 2022. The bill is still in committee in the Senate, although the legislative session has ended. Bill would require biomarker testing to be covered 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 evidence.https://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Senate%20Bills/5822.pdf#page=1
WEST VIRGINIA
WISCONSIN
WYOMING
GUAM
LAST UPDATED11/2/2211/2/22

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