SB24-124: Health-Care Coverage for Biomarker Testing

• Large group health benefit plans and individual/small group plans must provide coverage for biomarker testing for diagnosis, treatment, management, and monitoring of diseases when supported by medical and scientific evidence including FDA approvals, Medicare determinations, or nationally recognized clinical practice guidelines.

• Coverage is subject to standard annual deductibles, copayments, and coinsurance but not subject to annual or lifetime maximum benefit limits.

• Carriers may require prior authorization for biomarker testing consistent with existing procedures and must limit unreasonable disruptions in care, including limiting the need for multiple biopsies or biospecimen samples.

• Biomarker testing does not include screening purposes or direct-to-consumer genetic tests; it includes single-analyte tests, multiplex panel tests, and whole exome/genome/transcriptome sequencing.

• Large employer plans must implement coverage beginning January 1, 2025; individual and small group plans implement 12 months after federal confirmation that the coverage requirement does not require state defrayal under the Affordable Care Act.