Not all states mandate biomarker testing coverage

Each person's cancer has a unique pattern of biomarkers – genes, proteins, and other substances that can provide information about cancer specific to that individual. By testing for biomarkers, doctors can target the best treatment for each individual patient and they may not have to resort to generalized treatments like chemo and radiation that would not be as effective.  

Biomarker testing is recommended for more than half of the 62 cancer drugs introduced in the last five years. Studies demonstrate that cancer patients who receive biomarker-driven targeted therapy have better outcomes. In an American Cancer Society (ACS) survey, 89% of physicians said biomarker testing improves their ability to make more informed treatment recommendations.

Unfortunately, health insurance coverage lags far behind advances in biomarker testing.  In the ACS study, 66% of physicians report that coverage is a significant barrier to patients getting tested. Even with coverage, 39% of patients reported out-of-pocket costs as a barrier to biomarker testing.

While Congress has yet to bring Medicare coverage fully up to speed with advances in biomarker testing, many states are acting. Listed below are states that have already passed legislation requiring state regulated plans, including Medicaid, to provide coverage:

AZ, CA, IL, LA, RI, KY, NM, MD, MN, TX, GA, AR, OK

New York has passed legislation, but it has yet to be signed by the governor.  On December 20, advocates will hold a protest in Albany asking Gov. Hochul to sign the bill.

There are eight states in which legislation has been introduced but has yet to be passed. If you reside in one of these states, please contact your state legislator and express your support for coverage of biomarker testing:

CT, CO, FL, MA, ME, NV, OH, PA 

In the remaining 28 states, no legislation has been introduced to date. If you reside in one of these, please contact your state legislator and encourage that a bill be introduced. Let them know model legislation is available from the American Cancer Society Cancer Action Network.

Personalized medicine – the ability to specifically tailor treatment to the individual rather than one size fits all – is the future of quality health care. The finance side of the health care system must keep pace with this future.