The proposed bill seeks to improve patient access to biomarker testing by mandating coverage under health insurance plans for active and retired Commonwealth employees, Medicaid recipients, and individuals with private insurance. It amends Chapter 176G of the General Laws to define key terms related to biomarker testing and establishes that coverage must be based on established medical evidence, including FDA approvals and recognized clinical practice guidelines. The bill emphasizes the importance of minimizing disruptions in patient care, such as the need for multiple biopsies, and ensures that biomarker testing is covered for diagnosis, treatment, management, or monitoring of diseases.

Furthermore, the legislation outlines a streamlined process for prior authorization of biomarker testing, requiring insurance carriers to respond within 72 hours, or 24 hours in cases of significant health risk. If no response is received within the specified timeframe, the request is automatically granted. The bill also mandates that patients and healthcare providers have clear access to processes for requesting exceptions to coverage policies, which must be easily accessible on the insurance carrier's website. Overall, the bill aims to enhance patient care and outcomes by facilitating access to essential biomarker testing.