Committee reviews S154, which would direct cost study on insurance coverage for biomarker testing
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Summary
The committee reviewed S154, which would direct DFR and AHS to analyze the costs to private insurance and Medicaid of requiring coverage for biomarker testing and report estimated premium and state fiscal impacts by Jan. 15, 2027.
The committee reviewed S154 on April 3, a bill that would require state agencies to estimate the fiscal effects if Vermont were to mandate insurance coverage for biomarker testing. Barbara Janke Harvey of the Office of Legislative Council summarized the bill’s definitions and reporting requirements.
Harvey said the bill defines a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses” and defines biomarker testing to include single‑analyte tests, multiplex panels, protein expression analysis and whole exome/genome or transcriptome sequencing. She told the committee the bill steps back from an earlier coverage mandate and asks agencies to assess cost implications first.
The bill directs the Department of Financial Regulation and the Agency of Human Services to analyze costs associated with requiring health‑insurance and Medicaid coverage for biomarker testing when the test is supported by medical and scientific evidence (including FDA labeling or CMS coverage determinations), and to report to the committee and the Senate committee with jurisdiction on or before Jan. 15, 2027, with estimated premium increases and the state’s fiscal obligations. “On or before 01/15/2027, DFR would report to this committee and the senate committee’s jurisdiction on the estimated amount that health insurance premiums would increase,” Harvey said.
Committee members asked whether the draft includes an appropriation for actuarial work; Harvey said DFR did not specifically request an appropriation in the draft but a fiscal note may exist and that AHS believes it could use its current actuarial contract to perform some of the work. Members also sought clarity that Medicare is not part of the study, and Harvey confirmed Medicare coverage cannot be directed by the state and therefore is excluded from the statute’s coverage mandate.
The committee did not take a formal vote on S154 during the portion of the meeting in the transcript. The next procedural step described in the discussion is agency analysis and reporting by Jan. 15, 2027, after which legislators will decide whether to pursue a statutory coverage requirement based on the fiscal data.
