Bill > SB120

This bill requires health insurance carriers and the state Medicaid program to provide coverage for biomarker testing, which is a medical analysis of a patient's tissue, blood, or other biospecimen to detect specific biological indicators. The bill defines biomarkers as characteristics that can indicate normal or pathogenic biological processes, including gene mutations, protein expressions, and other molecular markers. Coverage must be provided for biomarker testing used in diagnosing, treating, managing, or monitoring a patient's disease or condition, when the testing demonstrates clinical utility through evidence such as FDA-approved test indications, drug warnings, Medicare coverage determinations, or recognized clinical practice guidelines. Health carriers and Medicaid must ensure coverage is provided with minimal disruption to patient care, limit the need for multiple biopsies, and establish a clear process for requesting exceptions to coverage policies. The bill requires prior authorization requests to be processed within 14 days for non-urgent cases and 72 hours for urgent cases, and mandates that the approval or denial process be transparent and accessible. The legislation will take effect on July 1, 2025, and while the fiscal impact is considered indeterminable, it could potentially lead to increased initial expenses but potentially offset costs through improved medical outcomes.