Bill > SB0435

This bill mandates that Tennessee health benefit plans, which are insurance coverage plans offered by health insurers, and TennCare health benefit plans, which are plans provided through an agreement with the state's TennCare program for medical assistance recipients, must cover biomarker testing starting January 1, 2027. Biomarker testing involves analyzing a patient's biological samples, such as tissue or blood, to identify specific characteristics (biomarkers) that can indicate normal biological processes, diseases, or how a patient might respond to certain treatments, including genetic factors. This coverage is required when a healthcare provider orders the test to diagnose, treat, manage, or monitor a patient's condition, provided the test is supported by medical and scientific evidence, such as FDA-approved indications, drug labels, or nationally recognized clinical practice guidelines. The bill also outlines requirements for insurers regarding the process for prior authorization, exceptions to coverage decisions, and reporting on the usage and cost savings of this testing, with the goal of ensuring continuity of care and providing clear access to information for patients and providers.