MA S809

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

Defines biomarker testing broadly to include single-analyte tests, multi-plex panel tests, protein expression analysis, and whole exome, genome, and transcriptome sequencing of tissue, blood, or other biospecimens.

Mandates prior authorization decisions within 72 hours, or 24 hours if delay poses significant health risk; requests without timely response are automatically deemed approved.

Requires coverage to minimize care disruptions, including avoiding the need for multiple biopsies or biospecimen samples.

Patients and prescribers must have access to a clear, readily accessible process on carrier websites to request exceptions to coverage policies or appeal adverse utilization review decisions.