New Jersey Assembly to Decide on Health Coverage for Biomarker Testing | Insurify

New Jersey may soon require health insurance providers to cover biomarker testing — which can detect evidence of disease-causing genes. Biomarker testing involves checking patient samples for these signs of certain diseases and conditions.

In October, a New Jersey Assembly committee voted to advance a bill that would require insurers to cover biomarker testing. If the Legislature passes the bill, it would expand coverage for screenings and tests that detect cancer, Alzheimer's, and a range of other diseases and behavioral health conditions.

Though some health insurance providers in New Jersey currently offer coverage for biomarker testing, it isn't a state requirement. The legislation would expand biomarker testing coverage to all policyholders in the state.

Knocking down a barrier

Lack of insurance coverage stops patients from getting needed tests, according to a nationwide survey conducted by the American Cancer Society Cancer Action Network (ACSCAN). Of the surveyed oncology health providers, 66% reported insurance coverage as a "significant or moderate barrier" to appropriate biomarker testing for patients.

"This legislation addresses a significant barrier by opening the door to precision medicine for more patients, regardless of their income, race or where they live," Quinton Law, government relations director for ACSCAN, said following the bill's advancement.

"Biomarker testing, an important step to accessing precision medicine, including targeted therapies, can help patients efficiently access the most effective treatment and may lead to many benefits, including better outcomes, improved quality of life and in some cases reduced costs from avoiding ineffective therapies," Law said in the statement.

How the bill defines biomarker testing

Health providers test for biomarkers by analyzing tissue, blood, or other biospecimens. If the test identifies indicators of a specific disease, condition, response to medicine, or gene characteristics, the health provider can start to better implement a care plan for the patient.

Under this bill, genetic disease-marker tests must have supporting medical and scientific evidence to qualify for coverage. The bill includes labeled warnings and precautions for FDA-approved tests and drugs, coverage determinations, and national clinical practice guidelines as eligible supporting evidence.

What's next: New Jersey could become 16th state to require biomarker coverage

Fifteen U.S. states have legislation requiring all state-regulated health plans to provide coverage for biomarker testing, and another five states have legislation that only requires coverage for state-regulated private plans, state employee health plans, or Medicaid.

New Jersey lawmakers initially introduced a companion bill to the Senate in April 2024, but the Senate bill hasn't yet advanced past the committee. The full General Assembly and the Senate will each need to approve the bill to pass the legislation into New Jersey law.

The bill isn't currently on the schedule for the remainder of the current legislative session, which ends on Dec. 19.

Hawaii, Massachusetts, Maine, Nevada, Ohio, Vermont, Washington, and West Virginia have also introduced legislation related to biomarker testing coverage.

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