Biological markers - or biomarkers - are molecules produced by the body that provide information. And those produced by tumors can provide insight into what type of cancer is present in the body and how aggressive it is. They also help doctors tailor cancer treatments.
But biomarker testing can be expensive, which limits its access for patients. Ohio Rep. Andrea White, R-Kettering, recently reintroduced legislation to expand insurance coverage for the testing.
We spoke to Leo Almeida, the government relations director with the American Cancer Society in Ohio, about the new legislative push.
This story has been lightly edited for length and clarity.
Leo Almeida: House Bill 8 was just introduced. This is actually the third time we've introduced this bill, and so we've been working on it for a couple of years now. And essentially what this bill will do is require private insurance, as well as Medicaid coverage, for biomarker testing. There are some guardrails in the bill. You can't just say 'I have cancer I want a biomarker test.' Your doctor has to point to specific scientific and medical guidelines and research that shows that you should have biomarker testing to determine your treatment.
And the reason for that being is that not every cancer has a targeted therapy based on biomarkers yet. There's still research being done on specific cancers, specific biomarkers. But for the ones that do, then the doctor can point to those guidelines and say, okay, my patient has lung cancer, we want to do a biomarker test to determine which treatment they should be on.
And so the bill will essentially create a level playing field. And right now some insurance cover some biomarker tests. They don't cover the ones that a patient might need based on those guidelines. We know that when we looked specifically at Ohio that, when it comes to insurance coverage for biomarker testing, 78% of commercial insurance plans provide coverage that is more restrictive than the National Comprehensive Cancer Network guidelines. And so that's actually one of the guidelines we put in our bill is NCCN guidelines to ensure that, you know, if a cancer patient does indeed need a biomarker test, that they'll have insurance coverage so that they can afford it. You might have a copay, you know, some cost sharing, but that would be less than if you didn't have insurance coverage or your insurance provider didn't cover the biomarker test that you need.
Jerry Kenney: You mentioned that you've been working on this for a couple of years, and, Rep. Andrea White has reintroduced this. So are you confident about the efforts this time around?
Almeida: We do face some opposition. We have worked with, those who oppose the bill, and there's not many. There are really just two organizations that oppose the bill compared to the over 70 organizations that support it. We, working closely with Rep. White did negotiate a couple of amendments. And so we made changes to the bill to tighten things up based on their requests. And in doing so, one of the groups that initially opposed it was the Ohio Chamber of Commerce, and they are now a supporter of the bill, because of the changes that we made.
Kenney: Can you give me a brief summary of what the opposition is?
Almeida: Yeah. So it's the NFIB, so the small business group association and then the Association of Ohio Health Plans oppose it on principle. They don't like legislators telling them what to cover. You know, certainly there can be a lot of arguments made for why legislation helps patients get access to what they should have, for what's medically necessary and that's kind of where we come to the table. The NFIB, they represent small businesses. They have a concern that this will increase premiums and that there will be higher costs for biomarker testing if the bill passes. We've passed this in 20 states already and have not seen increased prices. So they're concern about price gouging on biomarker testing because there's required coverage just hasn't happened.
And what we believe is that when it comes to costs, certainly no one wants to pay more for anything, right? But when we think about cancer, we want to be able to give Ohioans who are battling cancer the best chance of survival. And if they can't survive the disease but can live with the disease for longer, we can utilize biomarker testing to put them on the right treatment that will hopefully extend their life and give them a better quality of life. If you can go on a chemo pill versus going into traditional chemo and radiation, you're more likely to have less side effects and be able to return to your daily life quicker. And that's really important. Right? We hear from so many people who have battled cancer that utilizing biomarker testing and getting on a targeted therapy has given them more time with their family members.
