Friday, May 7, 2021

Very Brief Blog: Two State Bills Address Payers and Cancer Genomics

I can't speak to the odds of passage, but bills in the California and Louisiana state senates address genomics testing in cancer patients.

The bills are subject to amendment on a rolling basis, but I'll give key points of today's versions, here.  I provide links to the legislative websites.


SB 535 - Prior Auth re: Cancer Biomarker Testing

A health plan "shall be deemed to provide coverage of all generally medically accepted cancer screening tests."

After January 1, 2022, a plan shall not apply prior authorization to: biomarker for a patient with advanced or metastatic cancer, or biomarker testing for progression of such patients.

A biomarker test is a DNA or RNA alteration in order to guide patient treatment.  The bill has two nearly duplicate sections (which amend different underlying insurance laws), and both say that "biomarker" does not apply to biomarker testing that is not for an FDA-approved therapy.


SB-84 - Cancer Genomics

Any health plan in Louisiana "shall include coverage" for genetic or molecular testing for cancer including but not limited to tumor mutations, NGS, hereditary genetic testing, PGx testing, whole exome/genome, and biomarker testing.

Coverage is subject to applicable evidence-based-medicine criteria.

("Biomarker" is defined broadly).