More States Requiring Coverage of Cancer Testing Needed for Targeted Treatments
Earlier this month, Georgia Governor Brian Kemp signed HB85, which expands access to biomarker testing by requiring insurance companies to cover the procedure when there's medical and scientific evidence to support it. Nine other states have adopted similar laws requiring coverage for biomarker, or genomic profiling, which enables patients to receive precision cancer treatments based on the genetic profiles of their specific cancer.
Dr. Mathew Wayne Whitest, a primary care physician and prominent health and wellness educator in Crisp County, Georgia, says this testing and personalized cancer therapies are game changers. "However, there is a disparity in biomarker testing applications. Communities of color have not benefited as much from this new diagnostic and treatment tool. The costs have been major blockers. So, any means that will lower the barriers for access to treatments that improve treatment and survival rates for cancer patients is to be applauded."
Doctors usually suggest biomarker testing for people with cancer that has spread or returned after treatment. It's also routinely used to select targeted therapy for people diagnosed with certain types of cancer—including non-small cell lung cancer, breast cancer, and colorectal cancer. Still, while precision medicine has advanced rapidly over the last several years, health insurance plans haven't kept pace. Cancer patient advocates say lack of insurance coverage is a considerable barrier to many patients getting biomarker testing. Even when it is covered, patients often encounter high out-of-pocket costs or experience difficulties in obtaining prior authorization that delays treatment and can lessen outcomes.
Barriers to access and delays in treatment disproportionately impact patients insured through Medicaid, the government's health insurance program for lower-income Americans, further increasing cancer treatment outcome disparities. For example, the American Cancer Society found that patients with non-small cell lung cancer who were Black, older, or Medicaid-insured had lower odds of biomarker testing compared to patients who were White, younger, or commercially insured privately. Each state defines its own Medicaid coverage requirements. So the American Cancer Society's Cancer Action Network (ACS CAN) is waging a state-by-state campaign to require Medicaid and other insurers to cover biomarker testing.
In addition to Georgia, Arizona, Illinois, Louisiana, Rhode Island, Kentucky, New Mexico, Maryland, Arizona, and Texas have also adopted biomarker testing coverage legislation. Lawmakers in another 12 states have introduced measures this year that are still pending.
Social Health Research is located in New Jersey, where lawmakers still need to propose such a vital health equity measure. Jade Bechelli, NJ ACS CAN Government Relations Director, says, "Biomarker testing is key to opening the door to precision medicine and remains a critical asset in cancer care--and the treatment of other diseases. Right now, not all communities across New Jersey are benefiting from the latest advancements in biomarker testing and precision medicine. The American Cancer Society, Cancer Action Network, is eager to fix that and bring New Jersey in line with other states that have expanded access to biomarker testing."
Between 2016 and 2020, lung and breast were NJ's leading causes of cancer deaths. The American Cancer Society estimates that this year alone, 2800 New Jersey residents will die of lung cancer, and 1200 NJ women will die of breast cancer. Calls to several NJ lawmakers today were unreturned. Lawmakers in neighboring New York and Pennsylvania introduced biomarker testing coverage measures this year that are still pending.