Gov. Kathy Hochul reviewing biomarker testing bill that doctors say is game changer in treating cancer
LAKE SUCCESS, N.Y. -- A bill on Gov. Kathy Hochul's desk would make insurance companies cover what doctors call life-saving cancer genetic testing.
Biomarker testing helps create more targeted treatment plans. However, one-third of health plans don't currently cover it.
Hal Sieger recently thanked his doctor after reversing stage 4 melanoma.
"It was terrible, very bad. Everyone thought they were going to lose me," Sieger said.
He then underwent biomarker testing, the kind done at Northwell Labs. It's a rapid and cutting-edge profiling of a tumor to see if a patient has a genetic mutation that would be receptive to precision drugs.
Sieger's was given a new targeted drug, which immediately reversed the cancer.
"I'm cancer free and it's working," Sieger said. "Biomarker testing should be available to all patients. They want that chance to have the good news."
"Like a key in a lock, it targets that specific mutation and shuts the melanoma down," said Dr. Jeff Boyd, chief scientific officer at Northwell Health Cancer Institute.
Life saving, yet 32% of insurance carriers, including Medicaid, don't cover all biomarker tests, deeming them not medically necessary. A bill in Albany, passed nearly unanimously, would require it be covered just like other cancer treatments.
"If a doctor determines that a biomarker test would help them figure out the best course of medicine, it should be covered as standard of care," said Michael Davoli of the American Cancer Society.
"Biomarker testing reduces morbidity mortality form cancer. It's not an opinion. It's not a political opinion," Boyd added.
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It's a game-changing part of cancer care, but, until now, a group of 27 insurance providers resisted mandating the coverage. That opposition has since been withdrawn due to a revised bill that specifies medical guidelines.
Eric Linzer, president and CEO of the New York Health Plan Association, offered the following statement on the passage of the biomarker testing bill:
"Health plans recognize the importance of precision medicine and provide coverage for biomarker testing when supported by medical and scientific evidence. The original proposal would have established an overly broad set of criteria that had the potential to expose patients to tests that have not been proven to provide clinical benefits," Linzer said. "We appreciate that the sponsors amended the bill to address these concerns. The final bill takes a balanced approach of utilizing biomarker testing to inform the best treatment of care for patients through safe and effective testing that is supported by nationally recognized clinical guidelines."
The governor is reviewing the legislation. Northwell doctors say it will help reduce health disparities.
"It's just unconscionable that if you can afford $200 or $500 or $1,000, you can purchase it our of pocket and others cannot, especially about half the patients we care for," Boyd said.
"If you give the best treatment available, the cost of care goes down," added Dr. Richard Barakat, physician-in-chief at North Health Cancer Institute.
Biomarker testing is not only used in cancer treatment, but also in arthritis, preeclampsia, and more diseases every day. Doctors say it's saving time and money wasted in less effective treatments.
Twelve other states have passed similar biomarker testing laws.