NY A09149

Requires individual and group health insurance policies to cover biomarker testing for diagnosis, treatment, management, or ongoing monitoring of disease or conditions when supported by medical and scientific evidence.

Biomarker testing coverage must be based on FDA-approved or cleared tests, Medicare/Medicaid coverage determinations, or nationally recognized clinical practice guidelines and consensus statements.

Insurance policies and Medicaid must limit care disruptions by avoiding multiple biopsies or biospecimen samples when providing biomarker testing coverage.

Covered persons and prescribing practitioners must have access to a clear, readily accessible, and convenient process to request exceptions to coverage policies, with the process made available on insurers' websites.

Applies to individual policies under Insurance Law Section 3216, group policies under Section 3221, health service corporations under Section 4303, and Medicaid under Social Services Law Section 365-a, effective January 1, 2023.