Bill > LD107

This bill requires health insurance providers in Maine, including MaineCare, to cover biomarker testing under specific conditions. A biomarker is a measurable characteristic in the body that can indicate a biological process, disease, or potential response to treatment, such as a gene mutation or protein expression. The bill mandates that insurance policies provide coverage for biomarker testing when it is used to diagnose, treat, manage, or monitor a medical condition, and the test is supported by scientific evidence. This support can come from various sources, including FDA-approved test indications, drug approvals, medical warnings, Medicare coverage determinations, or recommendations from recognized clinical practice guidelines. The bill also requires insurance companies to process prior authorization requests for biomarker testing quickly, within 24 hours for urgent requests and 72 hours for non-urgent requests. Importantly, the coverage must be implemented in a way that minimizes disruptions to patient care, such as reducing the need for multiple biopsies. These requirements will apply to insurance policies that take effect or are renewed on or after January 1, 2026, ensuring that patients have access to potentially life-saving diagnostic and treatment guidance through advanced testing techniques.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=107&snum=132