This bill mandates health insurance coverage for biomarker testing, which is defined as the analysis of a patient's tissue, blood, or other biospecimen to identify biomarkers that indicate biological processes or responses to therapeutic interventions. The bill introduces new legal language into RSA 420-J, specifically sections 20 and 21, which outline definitions related to biomarker testing and establish coverage requirements for health benefit plans. Health carriers are required to include coverage for biomarker testing effective January 1, 2026, ensuring that such testing is available for diagnosis, treatment, and ongoing management of diseases when supported by medical evidence. Additionally, the bill stipulates that prior authorization requests for biomarker testing must be processed within specified timeframes, and a clear process for requesting exceptions to coverage policies must be made accessible to patients and providers.

Furthermore, the bill extends coverage requirements to the state Medicaid plan by amending RSA 167 to include biomarker testing under Medicaid coverage. This section mandates that Medicaid beneficiaries receive biomarker testing in accordance with the same standards established for health benefit plans, ensuring that testing is available for diagnosis and management of conditions. The bill also emphasizes the need to limit disruptions in care and outlines similar prior authorization requirements for Medicaid as those for health carriers. The act is set to take effect on July 1, 2025, and while it does not provide funding, it is expected to have indeterminable fiscal impacts on state revenue and expenditures due to the potential increase in testing and treatment costs.