New Law in Florida Requires State Health Plans to Include Biomarker Testing

MJP –

A recent state regulation broadens the availability of examinations that can aid healthcare providers in identifying and managing illnesses such as cancer and Alzheimer’s.

Florida Medicaid and state employee health insurance plans will be mandated to include biomarker testing coverage, as long as there is medical and scientific evidence to support it.

The process of biomarker testing consists of examining blood, tissue, or other bodily components to detect specific genes, proteins, or other elements that may indicate the presence of an illness.

When it comes to cancer, each individual’s cancer presents a distinctive collection of these biomarkers, also referred to as tumor markers. Conducting tests can assist patients and doctors in determining the most effective treatment strategy for their particular type of cancer, as well as eliminating options that may be ineffective.

Susan Harbin, senior government relations director for the American Cancer Society Cancer Action Network in Florida, emphasized the significance of considering both financial savings and the patient’s well-being. By doing so, it may be possible to prevent the need for harsh treatments like chemotherapy for patients with a lower risk of cancer recurrence.

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Biomarker tests are occasionally included in insurance plans, but Harbin noted that coverage has not kept pace with medical progress, leading to obstacles for many patients.

She expressed the importance of relieving patients from the burden of dealing with insurance companies and providers while managing their diagnosis and treatment plan. The goal is to alleviate the stress of figuring out out-of-pocket costs and payment for tests, allowing patients to focus on their health journey.

Supporters of individuals with Alzheimer’s disease are also rejoicing over the recent approval of HB 885 by Governor Ron DeSantis on June 18th. This will eliminate certain obstacles for individuals to undergo examinations such as spinal taps and PET scans of the brain, which are essential for diagnosing Alzheimer’s disease.

The blood tests that show potential for diagnosing the illness have not been approved by the FDA yet. According to Jennifer Braisted, who is the director of government affairs at the Alzheimer’s Association in Florida, providing state health plan members with coverage for biomarker testing at present will facilitate their access to blood tests in the future if they become more commonly accessible.

“We are truly stepping into the age of ‘prevention,’ therefore, if individuals can receive an early diagnosis, they may have the opportunity to access treatments that could modify the course of the illness,” she expressed. Therefore, the main focus is on guaranteeing people have the opportunity to access testing and ensuring that those displaying symptoms are being tested promptly, allowing them to spend more quality time with their family and friends.

According to the law, state insurance plans will only include tests that have been proven to provide medical benefits to the patient through scientific evidence. The coverage commences on the first day of January.

Florida lawmakers were encouraged by advocates to mandate the inclusion of biomarker testing in all state-regulated plans, yet private plans, like those available on the Affordable Care Act marketplace, were not included in the law.

According to the American Cancer Society, employees in the tourism, hospitality, and agriculture industries who do not receive coverage from their employers could face particular challenges due to this lack of inclusion.

Harbin praised the law as an “excellent initial move” and promised to continue advocating for broader inclusion in the times ahead.