This bill mandates health insurance coverage for biomarker testing, requiring that all health carriers include such coverage in their health benefit plans starting January 1, 2026. The bill defines "biomarker" and "biomarker testing," outlining the criteria under which these tests must be covered, including their clinical utility and alignment with FDA-approved indications, CMS determinations, and recognized clinical guidelines. Additionally, it stipulates that health carriers must limit disruptions in care, such as the need for multiple biopsies, and establishes timelines for prior authorization requests, requiring decisions within 14 days for non-urgent cases and 72 hours for urgent cases.

Furthermore, the bill extends these coverage requirements to the state Medicaid plan, ensuring that biomarker testing is available for diagnosis, treatment, and ongoing management of enrollees' conditions. The Medicaid plan must also adhere to similar criteria for coverage and provide a clear process for requesting exceptions to coverage policies. The effective date for this act is set for July 1, 2025. Notably, the bill introduces new legal language into RSA 420-J and RSA 167, while also amending existing provisions related to prior authorization timeframes, which may conflict with current regulations. 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 health outcomes.