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 includes a provision for the Agency of Human Services to request approval from the Centers for Medicare and Medicaid Services to amend Vermont's Medicaid state plan if necessary to implement the coverage for biomarker testing. The effective dates for the provisions are set for January 1, 2026, with the requirement that health insurance plans comply by that date or by January 1, 2027, at the latest. The Medicaid coverage will take effect either on January 1, 2026, or upon approval of the state plan amendment, ensuring that the necessary coverage is in place for patients requiring biomarker testing.