Lawmakers joined hundreds of cancer survivors in Albany on Tuesday in support of legislation requiring health insurance providers to cover biomarker tests for patients, but insurance companies not participating.
Tuesday’s Cancer Day at the Capitol focused on a new bill to require all health insurance policies that provide basic medical coverage and Medicaid to cover biomarker tests for diagnosis, treatment or to manage a person’s disease.
“We’re talking about the future of cancer care,” said Michael Davoli, senior director of government relations for the American Cancer Society Cancer Action Network. “What science has shown us is that precision medicine is the future, but to unlock precision medicine, we need to improve access to biomarker testing.”
Biomarkers measure a person’s biological processes, pathogens and responses to a particular treatment, and also identify genetic mutations that could influence the most effective treatment. Each person diagnosed with cancer has a unique disease, which means they would not benefit from all treatments.
Advocates at the American Cancer Society say it would ensure cancer patients in New York have access to precision medicine, or access to the best treatment available.
“Unfortunately, there are millions of New Yorkers who don’t have access to biomarker testing because their health insurance plans don’t cover it,” Davoli said.
It’s a treatment that would change Denise Roman’s life. The Saratoga Springs resident, originally from Colony in Albany County, battled and survived Hodgkin’s lymphoma 30 years ago with high-dose chemotherapy and radiation, followed by bone marrow and stem cell transplants.
“You may not have to go through a huge, long course of chemotherapy or radiation,” she said Tuesday. “You may be able to have this very precise treatment that works specifically on your cancer.”
Advocates argue the testing will eliminate over-testing and over-treatment, saving companies money in the long run.
Eric Linzer, president and CEO of the state Association of Medical Practitioners, says the bill sets overly broad criteria for requiring biomarker tests that may not be consistent with best medical practices.
The legislation would require federally approved biomarker tests to be covered, but Linzer says federal approval indicates the safety of a medical treatment, not when it should be used.
“While some tests may offer promising tools, in some cases there is inconsistency in published results,” Linzer explained. “And in some cases, there’s not enough evidence in the peer-reviewed literature.”
Linzer also rejected the argument that mandatory coverage of biomarker testing would be most cost-effective for insurance companies. Targeted therapies help patients get treatment faster and lower costs, but insurance providers continue to have concerns about the legislation’s broad scope and criteria.
“Defining a relatively broad set of criteria when the science and the literature really in some cases may have to catch up… The focus should be on making sure that what we cover is based on solid medical evidence and guidelines , based on clinical evidence [and] peer-reviewed literature,” he added.
Health care practitioners and insurance providers are eager to negotiate the proposal with lawmakers, but Linzer says they haven’t been invited into the discussion yet.
The bill’s senator, Roxanne Persault, says she’s prepared for pushback from health insurance companies to make changes to help save lives.
“The insurance companies will give up anything you ask them to do except raise insurance rates — they wouldn’t give up on that,” said Persaud, a Democrat from Brooklyn. “But we have to ask them where is the humanity in that when you know you can help someone, prevent something from causing someone’s untimely death?”
Other lawmakers, including Sen. James Skoufis, attended Tuesday’s event at the Legislative Office Building, saying they intend to sign on to support the legislation and bring it to the finish line this session after the state budget is completed.
The last scheduled day of the session is June 8.