Bill requiring health plans to cover biomarker testing moves to Newsom’s desk

A bill improving access to biomarker testing was enrolled and sent to Gov. Gavin Newsom’s desk on Sept. 6th.

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

Senate Bill 912, sponsored by Sen. Monique Limon (D – Santa Barbara), requires health plans to provide coverage for biomarker testing for the diagnosis, treatment, management, or ongoing monitoring of an enrollee’s disease or condition only if the test has been approved by the United States Food and Drug Administration, if a coverage determination has been made by CMS, or if the test falls under “nationally recognized clinical practice guidelines and consensus statements.”

The bill also applies these provisions to Medi-Cal managed care plans.

According to Limon, this bill will help ensure patients receive the right treatment at the right time.

“Targeted treatments will improve survival rates, quality of life, and reduce costs by connecting all patients to the most effective treatments,” the author’s position reads.

Supportive organizations include the American Cancer Society Cancer Action Network (ACS CAN), the University of California, California Life Sciences, the California Medical Association, and the California Chronic Care Coalition, among others.

In a statement, the ACS CAN said an improved access to precision medicine will play an integral role in improving outcomes for chronic diseases like cancer.

“Patients with certain lung cancer types who received biomarker testing and targeted therapy had a 31% reduction in mortality,” ACS CAN stated. “But to determine if a patient will benefit from certain targeted therapies, doctors must test for specific biomarkers – such as gene mutations – found in blood, tissues or other bodily fluids that provide insight into physiological processes, medical conditions or diseases.”

Many of the supportive organizations state that improving access to biomarker testing will allow patients to avoid other costly treatments that are ineffective or have more adverse effects. In a statement, Executive Vice President of University of California Health Carrie L. Byington, MD, said:

“The advances in cancer treatment that have come from being able to tailor approaches to a person’s individual condition are critical for winning the fight against cancer. This legislation will bring the hope and promise of precision medicine to people with a cancer diagnosis across the state on an equitable basis. California has the opportunity to be among the leaders in the nation with this legislation.”

Opposing organizations include the California Department of Finance, America’s Health Insurance Plans, Association of California Life and Health Insurance Companies, and the California Association of Health Plans (CAHP).

Many of the opposing organizations say this bill will increase health care costs and reduce competition. CAHP, in particular, notes the broadness of the biomarker testing category, and that while some tests in that category are up to the current standards of care, some are still only in experimental stages.

If Newsom signs the bill, California will join Arizona, Illinois, Louisiana, Rhode Island, and Washington as states that have enacted legislation requiring insurance coverage of biomarker testing.