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, including "biomarker," "biomarker testing," "clinical utility," "consensus statements," and "nationally recognized clinical practice guidelines." Health carriers are required to include coverage for biomarker testing in health benefit plans issued or renewed after January 1, 2026, ensuring that such testing is available for diagnosis, treatment, management, or monitoring of diseases when it provides clinical utility based on established medical evidence.

Additionally, the bill requires the state Medicaid plan to cover biomarker testing, as specified in a new section added to RSA 167. This coverage must also adhere to the same criteria for clinical utility and evidence as outlined for health carriers. The bill stipulates that both health carriers and the Medicaid plan must limit disruptions in care, including the need for multiple biopsies, and establish clear processes for prior authorization requests. The effective date for the bill is set for July 1, 2025. The fiscal impact of the bill is indeterminable, as it may lead to increased costs for insurers but could also result in savings through improved patient outcomes.