NC parents and doctors push for insurance coverage for a medical test they say saves lives

Ashley Fannin was working as a pediatric oncology nurse when her 6-year-old son Mason was diagnosed with leukemia.

Fannin says Mason, now 14, plays baseball and soccer and enjoys hunting, fishing and camping. He accompanied his mother to the Legislative Building this week to hear her advocate for insurance coverage for biomarker testing.

Fannin, who lives in Clayton, said biomarker testing helped Mason's doctors design a treatment plan for his aggressive form of cancer.

"It helped our doctors decide to increase the frequency of the steroids and chemotherapy from every three months to every month, and we went beyond the standard of care to do an extra year of treatment," she said.

Biomarkers are genetic material or proteins from a patient's tumors or blood that can be found by advanced lab testing. In cancer diagnoses, doctors analyze those biomarkers to help tailor treatments to the individual patient. However, the tests can sometimes be expensive, and some insurance plans don't cover them, leaving patients to bear the cost.

Representatives from the American Cancer Society Cancer Action Network, the Arthritis Foundation and the Alzheimer's Association are working to pass House Bill 567, which would require insurance plans to cover biomarker testing.

"In the cancer world, choosing the right treatment plan can mean the difference between a short life expectancy after diagnosis or walking away with a cure," said Rep. Grant Campbell (R-Cabarrus), a medical doctor and one of the bill's sponsors. "Biomarkers are intelligence that we can use to save lives and increase cure rates for patients."

The bill won easy approval in the state House last year, but has not received a Senate hearing.

Last year, the state Senate passed a bill mandating that any proposed legislation requiring health insurance to cover new services must also repeal requirements to cover the same number of other services. The bill requiring biomarker testing coverage does not meet that requirement.

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Campbell said the bill's prospects in the Senate are "to be determined," but said benefits to patients should not be treated "as a zero-sum game."

Melissa Horn, director of state legislative affairs at the Arthritis Foundation, said biomarker testing saves patients from enduring ineffective treatments, and can lower costs by getting patients effective treatments sooner.

Dr. Haley Simpson, an oncologist in Chapel Hill, said several patients she has cared for lacked biomarker testing coverage and ended up receiving "generic chemotherapy."

"Only months later, when their cancer had progressed and they had suffered the side effects of that chemotherapy," did their insurance approve biomarker testing, she said.

According to the American Cancer Society Cancer Action Network, 24 states have laws requiring insurance plans to cover biomarker testing. A handful of states limit coverage to certain kinds of insurance or certain diseases.

Courtesy of NC Newsline