The bill S.154, introduced by Senators Gulick, Brock, Major, and Vyhovsky, aims to mandate health insurance and Medicaid coverage for biomarker testing in Vermont. It introduces new legal language under 8 V.S.A. 4088n and 33 V.S.A. 1901n, defining biomarker testing and establishing the criteria under which health insurance plans and Medicaid must provide coverage. The bill specifies that coverage must be provided for biomarker testing when supported by medical and scientific evidence, including FDA-approved tests, indications for FDA-approved drugs, and nationally recognized clinical practice guidelines. Additionally, it emphasizes the importance of minimizing disruptions in patient care, such as the need for multiple biopsies.

The bill also requires the Agency of Human Services to seek approval from the Centers for Medicare and Medicaid Services to amend Vermont's Medicaid state plan if necessary to implement these coverage requirements. The effective dates for the provisions are set for January 1, 2026, with specific conditions for when they apply to health insurance plans and Medicaid coverage. Overall, this legislation seeks to enhance access to biomarker testing, which can play a critical role in the diagnosis and management of various medical conditions.