Bill > SB464

This bill mandates that various insurance providers, including the Public Employees Insurance Agency, the Bureau for Medical Services, and private health insurers, must cover biomarker testing when ordered by a treating physician for diagnostic, treatment, or monitoring purposes, provided the test is medically indicated and demonstrates clinical utility, supported by evidence such as FDA-approved indications, drug labels, or nationally recognized clinical guidelines. Biomarker testing involves analyzing a patient's biological samples for specific characteristics (biomarkers) that can indicate disease processes or responses to treatment, and the bill defines terms like "biomarker," "biomarker testing," "clinical utility," and "medically indicated" to clarify these requirements. Importantly, this coverage does not extend to screening individuals before a diagnosis, and insurers may require prior authorization for these tests, though patients and physicians must have a clear process to request exceptions, and the Public Employees Insurance Agency and Bureau for Medical Services are required to report on the costs associated with this coverage change.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=464&year=2026&sessiontype=RS&btype=bill