This bill mandates health insurance coverage for biomarker testing, requiring health carriers to include such coverage in their health benefit plans starting January 1, 2027. 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, ensure timely prior authorization processes, and provide accessible exception request procedures for patients and providers.

Furthermore, the bill extends these coverage requirements to the state Medicaid plan, mandating that it also covers biomarker testing in accordance with similar criteria. The Medicaid plan must ensure that coverage is provided without unnecessary disruptions and that prior authorization requests are handled promptly. The bill also requires the Department of Health and Human Services to submit necessary amendments to the Medicaid plan to comply with these new requirements. The effective date for the provisions of this act is set for July 1, 2026.