Biomarker legislation could improve patient access in 2024

Biomarker legislation could improve patient access in 2024

A new law passed in New York and legislation introduced in Ohio are just two of the latest examples of a legislative push to expand insurance coverage for biomarker testing.

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Several U.S. states, including New York, are expanding access to panel biomarker testing, which has the potential to improve patient outcomes, reduce side effects, enhance quality of life, and lower costs. New York recently passed legislation directing state-regulated health plans, including Medicaid, to cover comprehensive biomarker testing. The law mandates coverage for biomarker testing supported by medical and scientific evidence for diagnosis, treatment, management, or monitoring of a patient's disease or condition. At least 22 states are considering or actively opening up access to biomarker testing. The American Cancer Society Cancer Action Network reports that 12 states, in addition to New York, have enacted legislation requiring coverage in public and private insurance plans, with others introducing biomarker access bills.

Biomarker testing is considered a standard of care, and its adoption is expected to increase with molecular diagnostics and broader payment support. The Mayo Clinic and other healthcare institutions are using algorithms to analyze multiple biomarkers to measure disease progression and enhance care for various conditions. Advocates argue that broader biomarker testing can contribute to advancing health equity by tailoring treatments, conserving medical resources, and achieving the triple aim of healthcare. Studies suggest that broader biomarker testing can lead to substantial cost savings for payers by improving treatment precision and avoiding the costs of ineffective treatments. The Alzheimer's Association and other organizations are pushing for coverage expansion, emphasizing the importance of early diagnosis through biomarker testing, particularly for diseases like Alzheimer's, where early intervention can lead to more effective treatment and improved outcomes.

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