Biomarker testing must be covered by insurance under Minnesota law change
MINNEAPOLIS – Health insurance must cover biomarker testing, which can help identify the right treatment plan for cancer and other conditions, under a new policy passed in the Minnesota Legislature this year.
The testing can identify genes, proteins or other substances that provide important information about a person's cancer, which has a unique pattern of biomarkers that can sometimes impact if a treatment will work.
These tests have been around as a tool for physicians treating diseases for years. But the process is not cheap -- sometimes costing thousands of dollars depending on insurance. Starting in January 2025, though, health plans must cover it.
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"Biomarker testing is basically connecting the right patient with the right treatment at the right time," said Emily Myatt, regional government relations director for the American Cancer Society Cancer Action Network. "It can also help determine if a patient would have an adverse reaction to a treatment. And biomarker testing means better health outcomes, oftentimes less symptoms and side effects, and maybe even down the road lower health care costs."
Minnesotans battling cancer have long had this key tool in their fight. But it's not cheap, and insurance coverage varies.
Minnesota is joining a dozen other states that have passed similar laws, according to the American Cancer Society Cancer Action Network. The DFL-led legislature is also requiring insurance coverage for hearing aids, breast cancer screenings beyond a mammogram and birth control.
Myatt believes the change will lower health disparities by making the treatment tool more widely available to people. The law also requires medical assistance coverage.
"This bill says regardless of what disease you have or what stage or prognosis -- the bill isn't cancer-specific -- any biomarker test should be covered by insurance," she said.
Sen. Judy Seeberger, DFL-Afton, carried the bill at the State Capitol. She said biomarker testing helped doctors determine the right medication for her son, who has autism and other mental health issues.
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Her family's insurance did not cover it, meaning out-of-pocket costs that were upwards of $5,000, she recalled.
"We were fortunate enough to be able to afford that, Seeberger said. "And it really made a tremendous difference. It pointed us in the right direction of some medications that were very effective and very therapeutic and really worked for us."
During testimony in a committee hearing in March, Dr. Andrew Nelson, co-director of the molecular diagnostics laboratory at the University of Minnesota, told lawmakers the number of biomarker tests known to have an impact on patient outcomes has dramatically increased in the last two decades.
"The clinical utility of biomarkers is rapidly expanding in other disease states as well," Nelson said. "This bill will help streamline the biomarker testing process. Our patients and providers won't need to worry about insurance coverage for biomarker testing, which is a current barrier."