BILL NUMBER: S1196A
SPONSOR: PERSAUD
 
TITLE OF BILL:
An act to amend the insurance law and the social services law, in
relation to requiring health insurance policies and medicaid to cover
biomarker testing for certain purposes
 
PURPOSE OR GENERAL IDEA OF BILL:
This legislation will require that every state-regulated insurance plan,
including Medicaid, provide coverage for biomarker testing when
medically appropriate.
 
SUMMARY OF PROVISIONS:
Section 1 requires every individual accident and health insurance policy
that provides coverage for medical, major medical, or similar comprehen-
sive-type coverage shall provide coverage for biomarker testing for the
purposes of diagnosis, treatment, appropriate management, or ongoing
monitoring of a covered person's disease or condition. Defines criteria
for what types of medical and scientific evidence qualify as sufficient
medical and scientific evidence for biomarker testing.
Section 2 applies these same provisions to group or blanket accident and
health insurance policies
Section 3 applies these same provisions to all hospital service corpo-
ration or health service corporation
Section 4 applies these same provisions to Medicaid
Section 5 provides for the effective date
 
JUSTIFICATION:
In cancer care, biomarkers are often used to help determine the best
treatment for a patient. A "biomarker" is a sign of disease or abnormal
function that can be measured in blood, tissue, or bodily fluid.
Biomarker testing is the analysis of a patient's tissue, blood or fluid
biospecimen for the presence of a biomarker.
Progress in improving cancer outconkies increasingly involves the use of
precision medicihe. Biomarker testing is an important step for accessing
precision medicine, including targeted therapies that can improve survi-
vorship and better cancer patients' quality of life. Biomarker testing
is increasingly important for cancer care and for the treatment of other
diseases. Thirty- seven of the 62 oncology drugs launched in the past
five years require or recommend biomarker testing before use.
This legislation will ensure New Yorkers covered by state-regulated
insurance plans, including Medicaid, have coverage for biomarker testing
when medically appropriate.
Improving access to biomarker testing and thereby access to targeted
therapies is a strategy to reduce health disparities and improve
outcomes for cancer patients.
Ensuring equitable access to biomarker testing by improving coverage for
and access to testing across insurance types is key to reducing health
disparities. Indeed, without action like this to expand coverage for
biomarker testing - including Medicaid - advances in precision oncology
could increase existing health disparities.
Legislation to expand coverage of biomarker testing in New York would
make it possible for more patients to get the proper treatment at the
right time.
 
PRIOR LEGISLATIVE HISTORY:
2022: S8147 Referred to Insurance
 
FISCAL IMPLICATIONS:
Any cost of enacting this legislation is far overshadowed by ensuring
that the course of treatment used in treating an individual patient's
cancer is the most effective and cost-effective treatment.
 
EFFECTIVE DATE:
This act shall take effect April 1, 2024.

Statutes affected:
S1196: 3221 insurance law, 3221(l) insurance law, 4303 insurance law
S1196A: 3221 insurance law, 3221(l) insurance law, 4303 insurance law