House committee hears bill to widen evidence standards for state health-technology reviews

House Bill 1076 would alter the Health Technology Assessment Program by changing prioritization criteria, expanding acceptable evidence for rare or life‑threatening conditions, loosening limits on re‑reviews and tightening notification timelines, proponents and opponents told the House Health Care & Wellness Committee on Jan. 22, 2025.

The bill was presented to the committee by Representative Reid, who introduced the measure on behalf of Representative Holland. "This is a bill that addresses the work of the Health Technology Clinical Committee," Reid said, adding that the change would "provide the committee with guidance and flexibility in their evaluations and allow better treatment of rare conditions in our state." The sponsor specifically cited tumor‑treating fields (TTF), a device marketed as Optune Geo for glioblastoma patients, as an example of a technology that is FDA approved and covered by Medicare but not consistently covered for state Medicaid and public‑employee plans in Washington.

The bill would direct the HTCC to give priority to technologies for which patient access is established or recommended under Medicare or nationally recognized treatment guidelines, create special review criteria for life‑threatening or rare diseases that permit consideration of all applicable clinical trials and peer‑reviewed literature, and remove a current statutory restriction that re‑reviews consider only evidence developed since the previous review. It also would require the Health Care Authority to publish requests for new reviews and re‑reviews within seven days and require the clinical committee to issue a final decision within 180 days, including rationale for any negative determination.

Opponents included Health Care Authority Chief Medical Officer Dr. Judy Zirzentzuel, who voiced concerns that the bill could "degrade the evidentiary and unbiased basis of coverage determinations." "The HTA program was established by the legislature in 2006 with the goal of creating an unbiased and objective process to evaluate scientific evidence," Zirzentzuel said, noting the committee "leans heavily on randomized controlled trials" but does consider other data when appropriate. She warned the proposed criteria could lead to increased reviews of treatments with limited evidence.

Patients and clinicians urged flexibility for rare diseases. Lisa Woodard, a Spokane Valley resident and retired pharmacy professor whose husband has glioblastoma, said Optune Geo "is FDA approved and is covered by Medicare, most commercial insurances, and even Medicaid in many other states" but not by Washington public plans, calling that disparity "unfair." Dr. Lippi Bonham, director of neuro‑oncology at the Swedish Cancer Institute, told the committee many neuro‑oncology colleagues consider TTF standard‑of‑care and argued a sham‑device randomized trial would be unethical in this context.

Committee staff said the HTCC meets about five to six full days a year and that expanding topics or re‑review scope could increase committee and staff workload as well as vendor costs for evidence reviews. Dr. Zirzentzuel estimated additional staff and member reimbursements could follow if review volume increases.

Discussion at the hearing centered on balancing rigorous, unbiased evidence review with access for patients who have few options. Representative Marshall asked for clarification that the bill would not eliminate randomized clinical trials as the gold standard; Reid and staff agreed the bill seeks flexibility only in cases where RCTs are impractical or unethical.

No vote was taken at the hearing. Committee members heard in‑person and remote testimony and indicated willingness from the Health Care Authority to work with sponsors on possible amendments if the bill advances.

The committee will consider HB 1076 during its upcoming executive session schedule.