Insurers would be required to cover biomarker testing under pending state legislation — a move anti-cancer advocates hope would aid patients.
The measure on Wednesday was pushed by the American Cancer Society Cancer Action Network in New York as a way of ending out-of-pocket costs for the procedure, which would cover diagnosis, treatment or ongoing monitoring.
But the legislation has come under opposition from organizations representing insurance carriers, who questioned whether it would be in the best interest of patiens.
Biomarker testing uses genes or proteins to detect possible data about cancer.
“Timely access to guideline-indicated comprehensive biomarker testing can help achieve the triple aim of health care, including better health outcomes, improved quality of life, and, often reduced costs,” said Dr. Allyson Ocean, MD, Attending Physician specializing in gastrointestinal oncology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “Comprehensive biomarker testing can lead to treatments with fewer side effects and longer survival and allow patients to avoid treatments that are likely to be ineffective or unnecessary for some patients. Exposure to unnecessary or ineffective treatments can exacerbate the physical, emotional, and economic burdens of disease.”
The legislation in Albany has gained bipartisan backing, advancing through the Assembly Insurance Committee unanimously on Wednesday.
“In 2023, more than 123,810 New Yorkers are projected to be diagnosed with cancer, and nearly 31,320 are expected to die from the disease," said Michael Davoli of the American Cancer Society Cancer Action Network. "The state can work to lower these numbers by prioritizing legislation that will improve access to appropriate biomarker testing."
The New York Health Plan Association in a memorandum of opposition called the proposal well intentioned, but questioned the risks and benefits for the testing, calling them unknown.
"Further, creating new health insurance coverage mandates results in increased costs for individuals and employers purchasing health insurance in New York," the group wrote in the memo. "Mandating coverage of specific services disproportionately affect small and medium-sized employers. Forcing employers to include benefits they and their workforce may not want or need exacerbates the challenge they face to find affordable health care options."