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A01673 Summary:

COSPNSRDinowitz, Bronson, Raga, Lavine, Alvarez, McDonald, Paulin, Gunther, Seawright, Septimo, Thiele, Shimsky, De Los Santos, Steck, Davila, Rosenthal L, Santabarbara, Williams, Bichotte Hermelyn, Fahy, Buttenschon, Burdick, Simone, Jacobson, Benedetto, Aubry, Cruz, Clark, Simon, Ardila, Zebrowski, Dickens, Cunningham, Burgos, Durso, Maher, Brabenec, Slater, Manktelow, DeStefano, Barclay, Eachus, Magnarelli, Novakhov, Levenberg, Weprin, Meeks, Rozic, Pretlow, Reyes, Pheffer Amato, Walker, Kim, Taylor, Burke, Hyndman, Ramos, Wallace, Solages, Otis, Lee, Kelles, Lucas, McDonough, Gray
Amd 3216, 3221 & 4303, Ins L; amd 365-a, Soc Serv L
Requires health insurance policies and medicaid to cover biomarker testing for diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when the test is supported by medical and scientific evidence.
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A01673 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
  TITLE OF BILL: An act to amend the insurance law and the social services law, in relation to requiring health insurance policies and medicaid to cover biomarker testing for certain purposes   PURPOSE OR GENERAL IDEA OF BILL: This legislation will require that every state-regulated insurance plan, including Medicaid, provide coverage for biomarker testing when medically appropriate.   SUMMARY OF PROVISIONS: Section 1 requires every individual accident and health insurance policy that provides coverage for medical, major medical, or similar comprehen- sive-type coverage shall provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition. Defines criteria for what types of medical and scientific evidence qualify as sufficient medical and scientific evidence for biomarker testing. Section 2 applies these same provisions to group or blanket accident and health insurance policies Section 3 applies these same provisions to all hospital service corpo- ration or health service corporation Section 4 applies these same provisions to Medicaid Section 5 provides for the effective date   JUSTIFICATION: In cancer care, biomarkers are often used to help determine the best treatment for a patient. A "biomarker" is a sign of disease or abnormal function that can be measured in blood, tissue, or bodily fluid. Biomarker testing is the analysis of a patient's tissue, blood or fluid biospecimen for the presence of a biomarker. Progress in improving cancer outconkies increasingly involves the use of precision medicine. Biomarker testing is an important step for accessing precision medicine, including targeted therapies that can improve survi- vorship and better cancer patients' quality of life. Biomarker testing is increasingly important for cancer care and for the treatment of other diseases. Thirty- seven of the 62 oncology drugs launched in the past five years require or recommend biomarker testing before use. This legislation will ensure New Yorkers covered by state-regulated insurance plans, including Medicaid, have coverage for biomarker testing when medically appropriate. Improving access to biomarker testing and thereby access to targeted therapies is a strategy to reduce health disparities and improve outcomes for cancer patients. Ensuring equitable access to biomarker testing by improving coverage for and access to testing across insurance types is key to reducing health disparities. Indeed, without action like this to expand coverage for biomarker testing - including Medicaid - advances in precision oncology could increase existing health disparities. Legislation to expand coverage of biomarker testing in New York would make it possible for more patients to get the proper treatment at the right time.   PRIOR LEGISLATIVE HISTORY: 2022: A9149 Referred to Insurance   FISCAL IMPLICATIONS: Any cost of enacting this legislation is far overshadowed by ensuring that the course of treatment used in treating an individual patient's cancer is the most effective and cost-effective treatment.   EFFECTIVE DATE: This act shall take effect April 1, 2024.
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