Bill would require health insurance to cover biomarker testing

Lawmakers joined hundreds of cancer survivors in Albany on Tuesday to support legislation requiring health insurance companies to cover biomarker testing for patients, but insurance companies are not on board.

Tuesday’s Cancer Day of Action at the Capitol focused on a new bill that would require all health plans that provide comprehensive medical coverage and Medicaid to cover biomarker tests used to diagnose, treat, or treat a person’s disease.

“We’re talking about the future of cancer care,” said Michael Davoli, senior government relations director of the American Cancer Society’s Cancer Action Network. “Science has shown us that precision medicine is the future, but to unleash precision medicine, we need to increase access to biomarker testing.”

Biomarkers measure a person’s biological processes, pathogens, and responses to a specific treatment, and also identify genetic mutations that could affect the most effective treatment. Each person diagnosed with cancer has a disease unique to them, which means they would not benefit from all treatments.

Advocates for the American Cancer Society say it will ensure cancer patients in New York have access to precision medicine, or access to the best treatment available.

“Unfortunately, millions of New Yorkers don’t have access to biomarker testing because their health insurance doesn’t cover it,” Davoli said.

It’s a treatment that would have changed Denise Romand’s life. The Saratoga Springs resident, originally from Colonie, Albany County, battled and survived Hodgkin’s lymphoma 30 years ago with high-dose chemotherapy and radiation followed by bone marrow and stem cell transplants.

“You may not have to go through a big, long chemotherapy regimen or radiation regimen,” she said Tuesday. “You may be able to get this very targeted treatment that’s specific to your cancer.”

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Proponents argue the tests would eliminate excessive testing and treatment and save companies money in the long run.

Eric Linzer, president and CEO of the State Association of Health Practitioners, says the bill sets overly broad criteria for requiring biomarker testing that may not align with best medical practice.

The legislation would require federally approved biomarker tests to be covered, but Linzer says federal approval indicates a medical treatment’s safety, not when it should be used.

“While certain tests may offer promising tools, in some cases there are inconsistencies in the published results,” Linzer explained. “And there is insufficient evidence in the peer-reviewed literature in some cases.”

Linzer also pushed back on the argument that requiring insurance companies to cover the cost of biomarker testing would be most cost-effective. Targeted therapies help patients get treatment faster and reduce costs, but insurance providers remain concerned about the broad scope and criteria of the legislation.

“Setting a relatively broad set of criteria when the science and literature really have to catch up in some cases… The focus should be on making sure that what we cover is based on solid medical evidence and clinical evidence [and] peer-reviewed literature,” he added.

Health care practitioners and insurance providers are eager to negotiate the proposal with lawmakers, but Linzer says they don’t have to be invited to participate in the discussion just yet.

Bill sponsor Sen. Roxanne Persaud says she’s prepared for resistance from health insurance companies to make changes to save lives.

“Insurance companies will back down anything you ask them to do, except raise insurance rates — they wouldn’t back down on that,” said Persaud, a Brooklyn Democrat. “But we have to ask them, where is the humanity when you know you can help someone, prevent someone from dying prematurely?”

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Other lawmakers, including Senator James Skoufis, attended Tuesday’s event in the Legislative Office Building and said they intend to sign on to co-sponsor the legislation and get it across the finish line in this session after the state budget is completed.

The last scheduled meeting day is April 8th.