Biomarker legislation could improve patient access in 2024
Biomarker panel studies can unlock some of the mysteries of patient treatment, allowing them to experience fewer side effects, better quality of life, longer survival and potentially lower costs. At least 22 states are opening up or looking at how to open up access to it.
This past week, New York Governor Kathy Hochul signed Senate Bill 1196a/Assembly Bill 1673a into law requiring all state-regulated health plans, including Medicaid, to cover expanded biomarker testing, paving the way for more patients to access access to precision medicine treatments.
The new law means that “biomarker testing for diagnosis, treatment, appropriate management, or ongoing monitoring of a patient's disease or condition when the test is supported by medical and scientific evidence” is now required, according to a statement from the office of the governor.
“Bikemark testing has quickly become an integral part of healthcare as research shows it dramatically improves outcomes for patients suffering from a variety of diseases and conditions, including various cancers, arthritis, Parkinson's and more,” said State Senator Roxanne Persaud in the announcement.
It is quickly becoming the standard of care
Dr. Joel Diamond, CMO of Aranscia, shared Healthcare IT news earlier this month that molecular diagnostics and broader payments will drive further adoption, because they improve patient outcomes.
“We're starting to see this more and more as the standard of care,” he said.
The Mayo Clinic uses algorithms to analyze multiple biomarkers to measure disease progression and improve care for chronic kidney and cardiovascular disease, and late last year announced efforts to develop AI-driven diagnostic tests for liver and neurological diseases.
The American Cancer Society's Cancer Action Network said on its website that biomarker testing is key to unlocking precision medicine and that in addition to New York, 12 states have already passed legislation requiring coverage in both public and private insurance plans – Arizona, California , Georgia, Illinois, Kentucky, Louisiana, Maryland, Minnesota, New Mexico, Oklahoma, Rhode Island and Texas.
Arkansas has enacted legislation requiring commercial plans to include biomarker testing, and eight other states — Connecticut, Colorado, Florida, Massachusetts, Maine, Nevada, Ohio and Pennsylvania — have introduced biomarker access bills this year.
Promoting equity in healthcare
ACS-CAN has campaigned to increase access to biomarker testing in 14 states as it promises to achieve the Triple Aim of health care and improve health equity.
“Communities that are excluded, including communities of color, individuals of lower socioeconomic status, rural communities, and those receiving care at non-academic medical centers, are less likely to undergo biomarker testing,” the organization said on its Ohio campaign page.
In addition to saving medical resources and helping ensure patients receive personalized treatments, lawmakers were focused on the potential of broad biomarker testing to promote health care equity, said New York Assembly member Pamela Hunter.
“As medical capabilities advance and patients begin to see vastly improved health outcomes, we must strive to make the benefits of these new developments as equitable as possible,” she said in a statement about New York's newly signed biomarker testing law .
ACS-CAN said studies have shown that broader biomarker test results result in significant cost savings for payers by improving treatment accuracy and avoiding the costs of ineffective treatments.
“Improving coverage and access to biomarker testing across insurance types is key to reducing health disparities,” the organization said in an FAQ on the Ohio campaign page.
Alzheimer's disease is a disease where early diagnosis can lead to more effective treatment for dementia, according to the Alzheimer's Association.
The organization recently joined 50 others, including the AACS-CAN, the ALS Association and the Arthritis Foundation, to expand comprehensive biomarker testing, according to a story Tuesday in the Dayton daily news.
That association said Ohio House Bill 24 will promote diagnosis of Alzheimer's and other diseases for Ohioans by requiring Medicaid and state-regulated insurance plans to cover the cost of testing.
Ohio Medicaid already covers some biomarker tests, the story noted.
Treatments — there are two approved drugs for Alzheimer's disease and a third on the way — are aimed at patients who are beginning to experience forms of dementia, “making it important for people with those diseases to know sooner if they have it ” said Trey Addison, public investigator. policy director for Alzheimer's Association Ohio.
“The sooner they receive treatment, the longer they can potentially live on their own, remain in the labor market and earn a living,” he said, according to the newspaper.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.