Bill to require insurers to cover biomarker testing goes to Beshear-HEALTHYLIVE

MD Anderson Cancer Center graphic

By Melissa Patrick
Kentucky Health News

A bill to require private and public insurance plans in Kentucky to cover biomarker testing for cancer and screenings for genetic-based reactions to drugs has finally passed and is on its way to Gov. Andy Beshear. 

House Bill 180, sponsored by Rep. Kim Moser, R-Taylor Mill, will require all private insurance plans, Medicaid and the state-employee health plan to cover the biomarker and pharmacogenetic tests when they are medically necessary.

Pharmacogenetic testing determines how a patient will respond to medication. Biomarker testing “is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Each person’s cancer has a unique pattern of biomarkers,” says the National Cancer Institute.

Senate President Robert Stivers, R-Manchester, who carried the bill in the Senate, said he took it off the consent calendar, used to pass groups of non-controversial bills without a roll call, so senators and the public could become more aware of the bill's contents.

Stivers explained that biomarker testing allows for the targeted treatments of cancers, instead of a one-size-fits-all treatment for everyone. This "gives that individual a higher likelihood of being successful," he said. "As we become more technologically advanced, this is the direction that we hope medicine goes." 

Stivers said that while this bill is an insurance mandate, something the legislature traditionally resists, its financial analysis shows that it will have a minimal cost. The Kentucky Department of Insurance said it did not expect the bill to materially increase premium or administrative costs for fully insured health plans. Tt did not analyze the impact on Medicaid or the state-employee health plan. 

Sen. Danny Carroll, R-Benton, told the Senate members that he, his wife and his daughter, who has cerebral palsy, had recently undergone genetic testing to determine if his daughter would be a good candidate for a specific type of surgery, and learned that she was.

Carroll, who is president and CEO of Easterseals West Kentucky, also said pharmacogenetic testing is especially important for people with intellectual disabilities because it helps to determine which medicines work best for them: "This could very well change their life and the quality of life that they're able to live."

The American Cancer Society Cancer Action Network applauded the passage of the bill, noting that private health insurance and Medicaid coverage of biomarker testing have not kept pace with the rate of innovation.

“Dubbed ‘the right treatment at the right time,’ precision medicine has played a critical role in improving cancer outcomes,” Doug Hogan, government relations director for ACS, said in a news release. “Over 30,000 Kentuckians will be diagnosed with cancer this year. Ensuring patients who could benefit have access to insurance-covered biomarker testing to help identify the most appropriate treatment gives them a better quality of life and the best chance of survival.”

HB 180 passed the House 97-0 Feb. 22 and the Senate 34-0-1 March 13. Sen. Adrienne Southworth, R-Lawrenceburg, cast a "pass" vote.

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