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Cancer patient advocates push for biomarker testing coverage law

Doctors say biomarker tests help them tailor cancer treatments unique to the patient.
Doctors say biomarker tests help them tailor cancer treatments unique to the patient.

Biomarker testing looks at the genetic makeup of a person’s cancer and can help doctors tailor a treatment plan to each patient, leading to easier treatment with better outcomes, and, in some cases, reduced costs by avoiding ineffective medicines.

But the complex testing is expensive, ranging from hundreds to thousands of dollars per test. Insurance companies and Medicaid typically don’t cover most of the testing.

Last month, Ohio doctors and cancer organizations began lobbying lawmakers to pass House Bill 24, which would require insurers to pay for the tests. The bill was introduced in the Ohio House over a year ago.

Dr. Megan Kruse, a Cleveland Clinic oncologist, supports the bill.

"Without having the testing... we're really flying blind in terms of treatment recommendations," she said. "This information should be available to all patients, and it really should not be based on what insurance plan you have and what the out-of-pocket costs would be."

Kruse said some of her patients have gone into debt for the tests.

"More commonly, [my patients] may say, 'I know this is important for my cancer care. I'm going to do whatever I need to do to make it happen.' But we often don't hear about the bills as they come to them after the fact," she said.

Almost half of cancer patients have medical debt related to their cancer diagnosis, according to a May survey by the American Cancer Society.

The Ohio Association of Health Plans is opposed to requiring coverage because it would require their coverage of all biomarker testing.

“This essentially means the bill requires coverage of all biomarker tests, even if they are not FDA approved and don’t have the clinical evidence and data to justify use and coverage," said Gretchen Blazer Thompson, of the Ohio Association of Health Plans, in a written statement to the insurance committee last June.

The bill is still awaiting a vote in the House Insurance Committee.

Taylor Wizner is a health reporter with Ideastream Public Media.