Gov. Doug Ducey signs bill requiring health coverage for biomarker testing for precision medicine

Gov. Doug Ducey signed House Bill 2144 on Friday, a measure that will enhance statewide access to precision medicine. 

 

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The bill requires hospital and medical service corporations, health care service organizations, disability insurers, and group or blanket disability insurers to provide coverage for biomarker testing. It also directs the Arizona Health Care Cost Containment System (AHCCCS) and its contractors to provide biomarker testing for its members. 

This testing is used for the diagnosis, treatment, appropriate management or ongoing monitoring of a subscriber’s, enrollee’s or insured person’s disease or condition to guide treatment decisions when the test provides clinical utility as demonstrated by medical and scientific evidence. This evidence includes support by the FDA, CMS, or nationally-recognized clinical practice guidelines and consensus statements.

While signing the bill at the Dignity Health Cancer Institute at St. Joseph’s Hospital and Medical Center in Phoenix, Ducey said:

“These types of tests have become a crucial part of cancer and other disease therapies and should be available to everyone who wants one. Biomarker tests save lives. They help doctors determine the best course of treatment, prevent unnecessary treatments and will help us cure diseases like cancer in the future. No one should be denied this information.”

The bill’s sponsor, Rep. Regina Cobb (R–Kingman), highlighted the importance of tailored treatments for individuals with complex diseases such as cancer. 

“This bill will ensure that patients get the most affected treatment for their specific disease by using information about their genes and their proteins,” she said at a House Health and Human Services Committee meeting in February. “Tailoring the treatment not only improves the quality of the patients lives, but may actually save their lives, because patients with some of these diagnoses do not have time to waste with the wrong treatment.”

She said the bill also focuses on keeping doctors in control of what is medically necessary and appropriate for their patients, rather than leaving health plans in control of making decisions for their patients. Under the bill, health plans are required to ensure the coverage of these tests is provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples. Health plans must also provide a clear, readily accessible, and convenient process for subscribers, enrollees, or insureds and the prescribing practitioner to request an exception to the health insurer’s coverage policy.

Opponents of the bill largely cited their hesitation with coverage mandates in the marketplace, saying how they will raise taxpayer costs.

However, supporters of the bill refuted these claims and said that these precision treatments are designed to either keep patients healthy or prevent them from progressing to late stage disease, where they cost the health care system the most amount of money. 

Additionally, according to the bill’s fiscal note, AHCCCS does not expect the bill to yield a significant fiscal impact to its health plans, as the agency currently covers all but two biomarker codes for tests CMS deems useful for the clinical management of a patient. 

The bill’s provisions will go into effect on or after Jan. 1, 2023.