Starting January 1, Florida will mandate that state health plans cover biomarker testing, marking a pivotal advancement in diagnosing and treating diseases like cancer and Alzheimer's. This new regulation will apply to Florida Medicaid and state employee health insurance plans, ensuring coverage for biomarker testing when supported by medical and scientific evidence

Boosting Access To Biomarker Testing

Biomarker testing involves examining blood, tissue, or other bodily samples to identify specific genes, proteins, or molecules that could indicate the presence of disease. For cancer patients, this testing can reveal unique tumor markers, helping doctors customize treatment plans to the individual characteristics of their cancer. This personalized approach can enhance treatment outcomes and potentially avoid less effective treatments, such as chemotherapy, which can be challenging for patients.

Susan Harbin, Senior Government Relations Director for the American Cancer Society Cancer Action Network in Florida, underscores the significance of this coverage. "Biomarker testing not only offers potential cost savings but also improves patients' quality of life by targeting the most effective treatments and avoiding unnecessary procedures," she says

While some insurance plans already cover biomarker testing, advancements in medical technology have outpaced coverage, leading to challenges for many patients. "We aim to remove the additional stress of insurance complications while patients are managing their diagnosis and treatment," Harbin adds.

New Law, HB 885

The new law, HB 885, which Governor Ron DeSantis signed on June 18, is also a win for Alzheimer's advocates. The law will simplify access to diagnostic tests like spinal taps and PET scans, with future potential for blood tests pending FDA approval. Jennifer Braisted, Director of Government Affairs with the Alzheimer’s Association in Florida, highlights that early diagnosis can enable timely treatment, potentially changing the disease's trajectory.

The law mandates that state insurance plans cover biomarker testing only if there is scientific evidence of its medical benefit. However, this regulation does not extend to private insurance plans, including those available on the Affordable Care Act marketplace, potentially affecting individuals in industries without employer-based insurance, such as tourism and agriculture.

Harbin views this legislation as a "great first step" and continues to advocate for expanded coverage in the future.

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