MA H1227

Requires all Massachusetts health insurers, including the Group Insurance Commission, Medicaid, HMOs, and commercial insurers, to cover biomarker testing for diagnosis, treatment, management, or monitoring of diseases when supported by FDA approvals, CMS coverage determinations, or nationally recognized clinical practice guidelines.

Biomarker testing includes analysis of tissue, blood, or other biospecimens through single-analyte tests, multi-plex panels, protein expression tests, and whole exome, genome, or transcriptome sequencing.

Prior authorization decisions must be made within 72 hours, or 24 hours if delay poses significant health risk; requests are automatically approved if insurers fail to respond within required timeframes.

Coverage must be provided in a manner that limits disruptions to care, including avoiding the need for multiple biopsies or biospecimen samples.

Patients and prescribing practitioners must have access to clear, readily accessible processes on carrier websites to request exceptions to coverage policies or appeal adverse utilization review determinations.