Insurance legislators adopt biomarker testing model regulation

The National Council of Insurance Legislators adopted a model law to regulate how health insurers cover biomarker testing.

The NCOIL Biomarker Testing Insurance Coverage Model Act was passed by the Health Insurance and Long-Term Care Issues Committee and was subsequently adopted by the organization as a whole during its July summer meeting in Minneapolis.

Biomarker testing is becoming increasingly important to cancer care because it helps providers tailor cancer treatment when actionable biomarkers are present. While guidelines exist, insurance coverage of biomarker testing varies widely, as Milliman noted in a report last year.

The model will be sent to state legislatures for their consideration.

"“The consideration, lengthy deliberations, and passage of the biomarker model represents NCOIL at its best,” said NCOIL CEO Tom Considine. “We began from a position of wide disagreement and ended in a place with a strong consensus short of unanimity.”

Laws are changing quickly at state legislatures across the country as activists lobby for laws forcing insurers to cover biomarker testing. The NCOIL model law would only require coverage of biomarker testing post-diagnosis.

Wide-ranging debate

NCOIL members held a spirited debate over the biomarker model during a May conference call.

State Sen. George Lang, R-Ohio, a survivor of stage-four colon cancer, adamantly opposed the model on free-market grounds.

"I am strongly opposed to this bill and what this bill does," Lang said during the call. "This essentially comes down to government interfering with the private sector, with private markets. We should not be telling health plans what they should and should not do."

On the other side, Colorado state Rep. Dafna Michaelson Jenet, a democrat and two-time cancer survivor, helped pass a bipartisan biomarker bill out of committee in her state.

"I will tell you that being able to find the right treatment as opposed to trying this and trying that and seeing what's going to stick is very much an efficiency and an efficiency model that I would like to see adopt in adopted in our insurance plans," she said.

The Colorado bill requires all individual and group health benefit plans to provide coverage for biomarker testing if the testing is supported by medical and scientific evidence. It requires the commissioner of insurance to implement biomarker testing coverage for all individual and group health benefit plans issued or renewed on or after Jan. 1, 2025.

Biomarker testing is subject to the health benefit plan's annual deductibles, copayment, or coinsurance but is not subject to any annual or lifetime maximum benefit limit.

Just adds costs

Health plans are opposed to mandating biomarker coverage.

Miranda Motter is senior vice president of state affairs and policy at America's Health Insurance Plans. Biomarker legislation is not needed and would likely add costs into the treatment equation, she said on the May call, asking legislators to vote No in July.

In a statement, Considine said he is confident that NCOIL reached a satisfactory middle ground.

“The safeguards put in the bill brought it to a place where biomarker testing will simultaneously be enormously valuable to patients and reduce health care costs in the long term,” Considine concluded.

Senior Editor John Hilton covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected]. Follow him on Twitter @INNJohnH.

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InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected]. Follow him on Twitter @INNJohnH.