Bill > H567

This bill aims to ensure access to biomarker testing for North Carolinians by requiring health benefit plans to cover such testing when it is supported by medical and scientific evidence. The bill defines biomarker testing as the analysis of a patient's tissue, blood, or other biospecimen to identify biomarkers, which are characteristics that indicate normal or pathogenic biological processes or responses to medical interventions. Health insurers will be required to cover biomarker testing based on various criteria, including FDA-approved test indications, drug labels, national coverage determinations, and recognized clinical practice guidelines. The bill also prohibits insurers from discriminating against individuals based on genetic or biomarker information, meaning they cannot raise premiums, refuse to issue a health plan, or charge higher rates due to such information. Additionally, the bill extends these requirements to the State Health Plan and requires the Department of Health and Human Services to ensure Medicaid coverage for biomarker testing under existing laboratory services policies. These provisions are set to take effect on October 1, 2025, and will apply to insurance contracts issued, renewed, or amended on or after that date, with the goal of improving diagnosis, treatment, and care management for various medical conditions.

Budget and Finance, Government Affairs, Health and Social Services

https://www.ncleg.gov/BillLookUp/2025/H567