SB 1218 - Biomarker Testing Coverage

• Requires the Agency for Health Care Administration to cover biomarker testing under Medicaid for diagnosis, treatment, management, and monitoring of diseases or conditions supported by medical and scientific evidence.

• Mandates individual and group health insurance policies, as well as health maintenance contracts issued or renewed on or after July 1, 2023, to provide coverage for biomarker testing meeting specified medical and scientific evidence standards.

• Establishes that tests deemed covered include those approved by the FDA, indicated tests for FDA-approved drugs, tests with FDA drug label warnings, tests approved under Centers for Medicare and Medicaid Services coverage determinations, and tests supported by nationally recognized clinical practice guidelines or consensus statements.

• Requires insurers, HMOs, and Medicaid to ensure biomarker testing coverage limits disruptions in care, including coverage for multiple biopsies or biological specimen samples when needed.

• Mandates prior authorization decisions within 72 hours for nonurgent requests and 24 hours for urgent requests, and requires clear online processes for requesting coverage exceptions and appealing adverse utilization review determinations.