Health plans would cover medically supported biomarker tests for treatment

Health plans would cover medically necessary biomarker testing used to guide or inform treatment decisions. The provision covers individual, group, state employee, and public assistance health plans, including testing for diagnosis, treatment, disease management, or ongoing monitoring. The test must be supported by medical and scientific evidence, such as an approved test use, an approved drug indication, federal coverage guidance, or a recognized clinical practice guideline. Coverage must limit disruptions in care, including the need for multiple biopsies or other tissue samples. The requirement applies to policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.

Health plans may keep certain cost-sharing, provider, and utilization-management rules for covered biomarker testing. The rules apply to covered biomarker testing under the individual, group, state employee, and public assistance plan provisions. Plans may use deductibles, coinsurance, payment limits, coordination-of-benefits rules, and approved-provider or facility limits. The provisions do not require coverage for screening or investigatory and experimental biomarker tests. The individual and group provisions exclude limited-benefit policies, such as accident-only, hospital indemnity, disability income, and long-term care policies. These rules apply to policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.