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 can inform treatment decisions. The new legal language inserted into RSA 420-J establishes definitions for "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, amended, or renewed after January 1, 2026, ensuring that such testing is available for diagnosis, treatment, management, or monitoring of diseases when it demonstrates clinical utility. The bill also outlines the criteria for coverage, including FDA indications and recognized clinical guidelines, and mandates that health carriers limit disruptions in care and provide a clear process for prior authorization requests.

Additionally, the bill requires the state Medicaid plan to cover biomarker testing under similar conditions, ensuring that beneficiaries receive the same scope and frequency of testing as provided under the Medicaid program. The new section added to RSA 167 specifies that the Department of Health and Human Services must submit any necessary amendments to the Medicaid plan to facilitate this coverage. The bill also introduces specific timeframes for prior authorization requests and mandates that both enrollees and providers have access to a straightforward process for requesting exceptions to coverage policies. 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 expenditures and revenues.