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Advocates, patients press Joint Committee to require insurer coverage for biomarker testing
Summary
Patients, clinicians and advocacy groups told the Joint Committee on Financial Services that biomarker tests — genomic and protein assays that guide targeted cancer and Alzheimer’s treatments — must be covered routinely by insurers to speed correct treatment, reduce costs and close equity gaps.
Lawmakers heard hours of testimony Tuesday urging the Joint Committee on Financial Services to require private insurers to cover biomarker testing when medically appropriate, citing patient stories and clinical outcomes.
Speakers told the committee that biomarker tests — including genomic panels, liquid biopsies and amyloid assays — can identify targeted therapies for cancer and disease‑modifying treatment for Alzheimer’s disease, but that patchwork coverage and denials delay care or leave patients to pay thousands out of pocket.
Supporters said broader coverage would improve outcomes and reduce long‑term costs. ‘‘Timely access to guideline‑indicated comprehensive biomarker testing will enable more patients to access the most effective treatments for their disease and can potentially help with achieving the triple aim of better health outcomes, lower costs and improved quality of life,’’ said Mark Heimovitz, government relations director at the American Cancer Society Cancer Action Network, citing disparities for rural and marginalized patients.
Patients described the impact in personal terms. Maggie Buswick, who said biomarker testing guided treatment for her thyroid cancer at age 13, told the committee the testing ‘‘gives my doctors precise tools to guide my treatment that keeps me healthy.’’ Chung E. Han, a lung cancer survivor, said insurers repeatedly denied liquid biopsy claims that identified an ALK fusion that allowed her to take a targeted oral medication and avoid chemotherapy. ‘‘The insurance companies denied each claim for biomarker testing,’’ Han said. ‘‘The reason for their denial was noted as medically unnecessary.’’
Clinicians described cases where testing changed care quickly. Dr. Amr Kalkar, an oncologist at Dana‑Farber Cancer Institute, said biomarker results allowed clinicians to start targeted oral therapy ‘‘within days instead of weeks’’ and avoid chemotherapy for some patients. Laboratory directors reported wide variation in payor reimbursement: some insurers routinely pay for the tests; others decline nearly all claims, leaving major centers to absorb costs or delay testing.
Patient advocates highlighted non‑oncology uses: Lainie Tayasaman of the Alzheimer’s Association noted that disease‑modifying Alzheimer’s drugs require evidence of amyloid pathology, typically via PET scan or cerebrospinal fluid testing, and that early diagnosis linked to biomarker testing can enable timely treatment and planning.
Speakers also urged the committee to consider the practical equity implications. Several witnesses said academic centers and large hospitals were more likely to offer testing while community hospitals and rural patients were left behind when payors denied coverage. Data presented to the committee indicate 20+ states have enacted similar coverage mandates in recent years.
The bills before the committee are House 12,227 and Senate 8,09. Witnesses asked the committee to report the bills favorably and said they would follow with written data detailing reimbursement patterns and clinical guidelines.
Lawmakers did not take a vote at the hearing. The committee said it will accept written materials and follow up with staff briefings as it evaluates the bills.
