A new state law expands access to tests that can help medical professionals diagnose and treat diseases like cancer and Alzheimer's.
It will require Florida Medicaid and state employee health insurance plans to cover biomarker testing when supported by medical and scientific evidence.
Biomarker testing involves analyzing blood, tissue, or other parts of the body to check for certain genes, proteins, or other substances that could be a sign of disease.
In the case of cancer, each person’s cancer has a unique set of these biomarkers, also known as tumor markers. Testing can help patients and doctors identify the best treatment plan for their specific cancer and rule out what may not work.
“Which is also really important when you're looking at not only cost savings, but also quality of life for the patient, so potentially maybe you can avoid things like chemo[therapy] that can be really hard on the body because maybe you have a cancer that's less likely to recur,” said Susan Harbin, senior government relations director for the American Cancer Society Cancer Action Network in Florida.
Insurance plans sometimes do cover biomarker tests, but Harbin said coverage has not kept up with medical advancements and said many patients face hurdles.
“We don’t want patients, on top of dealing with the diagnosis and figuring out a treatment plan, to also face issues going back and forth with their insurance company or their providers to see if they’re going to have to pay out of pocket, figuring out how they’re going to pay for these tests, you know we want to take at least that part of the trouble off of their plates,” she said.
Advocates for patients with Alzheimer’s disease are also celebrating the new law, HB 885, which Gov. Ron DeSantis signed on June 18. It will remove some barriers for people to get tests like spinal taps and PET scans of the brain, which can help diagnose Alzheimer’s.
Blood tests to diagnose the disease are showing promise, but do not yet have FDA approval. Ensuring state health plan enrollees have coverage for biomarker testing now should make it easier for patients to access the blood tests in the future if they become more widely available, said Jennifer Braisted, director of government affairs with the Alzheimer’s Association in Florida.
Now that there are FDA-approved medications that can slow the progression of Alzheimer’s in early stages, Braisted said it’s critical that people showing symptoms of the disease get answers quickly.
“We’re really starting to enter that era of ‘prevent,’ so if people have the ability to get diagnosed earlier, they’re able to potentially get on these treatments that can alter the disease,” she said. “So it's really all about making sure people have access and ensuring that individuals who do have signs are getting tested and ensuring that they have more time with their loved ones.”
The law stipulates that state insurance plans shall only cover tests if scientific evidence indicates they will medically benefit the patient. Coverage begins on Jan. 1.
Advocates had urged Florida lawmakers to require all state-regulated plans to cover biomarker testing, but the law leaves out private plans, such as those offered on the Affordable Care Act marketplace.
The American Cancer Society notes tourism, hospitality and agriculture workers who aren’t offered coverage through an employer could be especially affected by that omission.
Harbin called the law a “fantastic first step” and vowed to keep pushing for expanded coverage in the future.
