SB 464
Requiring insurance coverage for biomarker testing
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to ensure that insurance coverage is available for biomarker testing in West Virginia. It defines key terms like ‘biomarker’ and ‘biomarker testing,’ and establishes criteria for when such testing should be covered, including when it’s medically indicated and provides clinical utility as demonstrated by scientific evidence or nationally recognized clinical practice guidelines. The bill also requires reporting on the costs associated with this change in coverage.
Key provisions
- Defines ‘biomarker’ and ‘biomarker testing’ for the purpose of the bill.
- Requires insurance coverage for biomarker testing when ordered by a treating physician and medically indicated.
- Specifies criteria for clinical utility, including FDA approvals, drug labels, CMS coverage determinations, and national clinical practice guidelines.
- Prohibits coverage of biomarker testing solely for screening purposes.
- Allows for prior authorization requirements for biomarker testing.
- Establishes a process for requesting exceptions to coverage policies.
- Requires a report on the cost of the change in coverage after one year of implementation.
- Addresses disruptions in care, such as the need for multiple biopsies.
Who is affected
- West Virginia residents
- Health insurers
- Physicians
- Labor unions (Public Employees Insurance Agency)
- Healthcare providers
Notable changes
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