This bill amends the Code of West Virginia to mandate coverage for biomarker testing under the West Virginia Public Employees Insurance Act and within the Human Services and Insurance sectors. It introduces definitions for key terms such as "biomarker," "biomarker testing," "clinical utility," and "nationally recognized clinical practice guidelines." The bill requires health insurers to provide coverage for biomarker testing when ordered by a treating physician, ensuring that the tests are medically indicated and demonstrate clinical utility based on established medical evidence. Importantly, it specifies that coverage is not required for screening purposes prior to a diagnosis and emphasizes the need for a streamlined process for requesting exceptions to coverage policies.

Furthermore, the bill allows health insurers to require prior authorization for biomarker testing and mandates that both the covered person and the treating physician have access to a clear process for requesting exceptions, which must be easily accessible on the insurer's website. The legislation aims to minimize disruptions in patient care, such as the need for multiple biopsies, while ensuring that biomarker testing adheres to FDA-approved standards and established clinical practice guidelines. Overall, the bill seeks to enhance access to biomarker testing, which is essential for effective diagnosis and management of various diseases and conditions.

Statutes affected:
Introduced Version: 5-16-7h, 9-5-34, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z