State Legislative Trends in Biomarker Testing

The standard of care for informing the selection of the most appropriate targeted therapy for many patients with advanced cancer is comprehensive biomarker testing (Cancer. 2022; 128(15):2865-2870. doi:10.1002/cncr.34271).

Galareh Sadigh, MD, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia and colleagues indicated that despite evidence demonstrating the need for comprehensive biomarker testing to enable the selection of appropriate targeted therapies and immunotherapy, the integration of biomarker testing into clinical practice lags behind recommendations in National Comprehensive Cancer Network guidelines.

They also indicated that differences in coverage policy across insurance health plans have limited the accessibility of comprehensive biomarker testing principally to patients whose insurance covers the recommended testing or those who can pay for the testing, and this has resulted in health disparities.

Moreover, even when insurance coverage exists for recommended biomarker testing, depending on their insurance plan benefits, patients may incur out-of-pocket costs, which may also generate barriers to testing. For some patients, prior authorization for biomarker testing can also add an administrative burden and may postpone testing and thus treatment if it is not performed in a judicious manner.

Recently, three states (Illinois, Louisiana, and California) passed laws designed to enhance access to biomarker testing at the state level. However, there is variability among these laws with regard to the population affected, the stage of cancer, and whether the coverage of testing is mandated, or the legislation addresses only prior authorization.

The authors wrote, “Advocacy efforts by patient advocates, health care professionals, and professional societies are imperative at the state level to further improve coverage for and access to appropriate biomarker testing.”