Legislative committee sends S.154 for actuarial study after testimony on biomarker testing

A legislative committee on April 9 moved S.154 — legislation about insurance coverage and a fiscal study of biomarker testing — to an actuarial review after testimony from state health officials, patient advocates and insurers.

For the record, Alex McCracken, Director of Communications and Legislative Affairs for the Department of Vermont Health Access, told the committee the department "appreciate[s] the changes that were made" and that it can produce the actuarial study within its existing contract without a new appropriation.

The bill originally sought mandated coverage of certain biomarker tests for conditions such as cancer and Alzheimer’s disease. Witnesses who urged the committee to advance the concept said the tests can enable earlier, more accurate diagnoses and better-targeted treatment. "Biomarker testing offers one of the best ways to get a diagnosis," Jenny Horgan, government-relations director for the Alzheimer’s Association in Vermont, told members, saying early diagnosis allows earlier intervention and can improve quality of life.

Caregiver testimony underscored the human consequences. "My wife, Judy Simon Bouton, died almost three years ago from complications of Alzheimer's," testified John Bouton of Hartford, recounting long waits for specialist care and the burden of caregiving. He urged lawmakers to remove access barriers to testing and treatment.

The American Cancer Society’s advocacy arm said it supports an actuarial study as a first step. "Timely access to guideline-indicated comprehensive biomarker testing will enable more patients to access the most effective treatments for the disease and can potentially help achieve the triple aim of health care: better health outcomes, improved quality of life, and reduced costs," Mike Rollo, Government Relations Director for ACS CAN, said.

Insurers cautioned that costs and downstream effects need close study. Courtney Harness of Blue Cross & Blue Shield of Vermont said the company covers tests that become medically necessary but urged caution because Vermont pays unusually high laboratory rates: "We literally have the highest laboratory cost in the country," she said, adding that mandates can trigger cascades of follow-up testing and services that drive cost.

Witnesses and committee members cited key numbers discussed during the hearing: the Alzheimer’s Association estimated about 12,800 Vermonters age 65 and older currently living with Alzheimer’s or another dementia; a national analysis cited during testimony put potential per-person savings from earlier diagnosis at about $63,000 (roughly $30,000 Medicare, $20,000 Medicaid and $13,000 other savings). Witnesses gave negotiated test-price ranges as approximately $46 to a bit over $200 on average for commonly used blood-based biomarkers, while some specialized tests can cost thousands. A New Hampshire Medicaid estimate presented ranged roughly from $150,000 to under $600,000 depending on uptake assumptions.

Committee members and legislative counsel discussed narrowing the study’s scope so the Department of Financial Regulation (DFR) can complete an actuarial analysis estimating premium impacts and the state’s fiscal exposure. Jen Carberry of the Legislative Council said the first DFR report would estimate how much premiums might increase and what the state’s financial obligations to Medicaid and state employee plans could be; the committee asked staff to work with DFR and with Commissioner Mary Block (referenced in testimony) on the language.

The committee agreed to proceed with the actuarial analysis and requested draft language edits; the Department of Financial Regulation indicated it could perform the work within existing resources if the study’s scope is limited. The report is scheduled to be completed by Jan. 15, 2027, with follow-up work by the Agency of Human Services on federal approvals that might be required for Medicaid coverage.

No formal vote on mandated coverage was taken; the committee will return the item to the agenda for further drafting and review.

Asked about next steps, the chair said staff would coordinate with legislative counsel and bring revised language back to the committee, likely next week. The committee adjourned after confirming the timetable.