A test can help doctors treat cancer. But Ohio doesn't require insurers pay for it

Facing a relapse of rare acute myeloid leukemia, Alique Topalian didn't think twice about giving doctors a bone marrow sample for testing that would help them better treat her cancer.

Topalian, 30, was among the first patients to use biomarker testing when she was first diagnosed with leukemia at age four. Back then, the testing wasn't widely accessible. By the time Topalian relapsed in 2021, it was becoming the standard of care − comparable to a roadmap for treating cancer.

But as Topalian was leaving the hospital months later, she learned that her health insurance would not cover biomarker testing because it wasn't medically necessary. Topalian spent a year documenting months of specialists' visits to convince her insurance otherwise.

"It was such a pain and so stressful because it was this thing that my doctors told me is the future and this is how we treat you now, and my insurance is going to say that it's not medically necessary," said Topalian, who works in Cincinnati and lives in Toledo as her husband attends medical school.

Enter Ohio House Bill 24, which would require Medicaid and private health insurance to cover all FDA-approved biomarker testing that a doctor deems medically necessary. There are some limits: biomarker testing couldn't be used for screening alone.

Biomarker testing uses a sample of tissue, blood, bone marrow or another bodily fluid to check for genes, proteins or other molecules that offer clues about a person's cancer, according to the National Cancer Institute. That information can help doctors pick a treatment that works best for that individual's cancer.

Rep. Andrea White, R-Kettering, is sponsoring the bill, which she says will improve patients' outcomes and save money by avoiding the wrong treatments.

"The more I learned, the more convinced I was that the human case and the business case are there for passing biomarker testing coverage in Ohio," White said. "It's the national standard of care, and Ohio ranks among the bottom states in coverage."

The bill is backed by the American Cancer Society Cancer Action Network, Ohio Hospital Association and dozens of medical groups.

Opposition from health insurers, small businesses

But health insurance companies say they already cover some biomarker testing, and they are wary of costly mandates that could hurt their ability to negotiate prices.

"Many plans already offer coverage of multiple biomarker tests that are determined to have the clinical evidence and data to back up the efficacy of the testing," said Kelly O’Reilly, president and CEO of the Ohio Association of Health Plans. “Despite our support for the technology, OAHP opposes the bill because it mandates that all biomarker tests be covered."

A single-panel test costs private insurers about $224 and Medicaid about $78.80. However, more advanced tests cost more.

In 2020, 44% of cancer patients paid an out-of-pocket cost for biomarker testing and one-third paid more than $500, according to a 2020 American Cancer Society Cancer Action Network survey of 933 patients. Patients whose insurance didn't cover the test faced bills of more than $10,000.

The National Federation of Independent Business also opposes the bill, saying it will drive up premiums for employers.

Still, White is encouraged by positive conversations with the Ohio Chamber of Commerce, which is currently neutral on the bill. Ohio Chamber spokeswoman Amanda Ehrmantraut said it wants to ensure proper guardrails are in place to avoid "runaway costs while also providing a biomarker solution that lowers health care costs down the road and provides for a healthier workforce."

A similar bill passed the House's health committee last November but that was too late for a full review by the House and Senate. Now, the bill is awaiting a vote in the House Insurance Committee.

'It's a no-brainer for me'

For BethAnn Ennis, 54, of Reynoldsburg, biomarker testing is the future of cancer treatment. Ennis treats her lung cancer at home with a daily pill − a targeted treatment made possible because biomarker testing detected a rare gene mutation.

The pills are a marked difference from the surgery, extensive chemotherapy and radiation treatments that marked her first round with cancer at age 48. But tissue extracted from that treatment helped her to chart a different course when the cancer returned 18 months later.

Ennis isn't sure whether her insurance or researchers at Ohio State University's James Cancer Treatment and Research Center covered the bill for biomarker testing, but she is grateful.

With eight weeks of targeted treatment, Ennis went from stage four advanced to no evidence of disease. At the same time, she was able to care for her mother and volunteer at her church.

"Without that biomarker testing, I would not be alive today," Ennis said. "It's a no-brainer for me. This tool should be available."

Jessie Balmert is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

This article originally appeared on Cincinnati Enquirer: A test can help doctors treat cancer. But Ohio doesn't require insurers pay for it