Rep. Martin Joins American Cancer Society Push for Biomarker Testing Coverage

NASHVILLE — State Rep. Brock Martin (R-Huntingdon) and State Sen. Shane Reeves (R-Bedford, Cannon, Moore and Rutherford) joined the American Cancer Society to discuss legislation that would expand health insurance coverage for biomarker testing in Tennessee.
“When faced with a cancer diagnosis, Tennesseans should not be fighting insurers while fighting for their lives,” said Rep. Brock Martin. “Biomarker testing provides a clear path forward for care and leads to better health outcomes and significant cost savings by avoiding ineffective treatment. This legislation puts patients first by providing clarity rather than confusion and ensuring medical advancements do not outpace our health care system.”
Often used in cancer care to help physicians identify the most effective treatment for a patient, biomarker testing is also increasingly used to guide care for other serious conditions such as autoimmune and neurological diseases, cardiovascular disorders, arthritis and preeclampsia. Currently, insurance coverage for biomarker testing has not kept pace with medical advancements, often leaving patients with delayed care or significant out-of-pocket costs.
"Tennesseans battling cancer, Alzheimer's, arthritis or other life-altering conditions deserve access to the most precise tools medicine has to offer, without bureaucratic roadblocks from insurers standing in the way,” said Senator Reeves. “By requiring coverage for biomarker testing, this bill ensures our health care system keeps pace with scientific progress, delivering targeted treatments that improve outcomes, reduce unnecessary suffering and save costs in the long run.”
House Bill 0484/Senate Bill 0435 would require state-regulated health insurance plans to cover biomarker testing when ordered by a health care provider for diagnosis, treatment or ongoing monitoring of a patient’s disease or condition. The legislation does not include coverage for the cost of screenings, but does offer provisions to ensure testing is supported by medical and scientific evidence.
While comprehensive biomarker testing can carry a higher upfront cost, it leads to better outcomes and long-term savings by avoiding ineffective or unnecessary treatments. Patients who received comprehensive biomarker testing experienced an average savings of approximately $8,500 per member per month in total cost of care, according to a CVS Health–sponsored study published in the Journal of Clinical Oncology.
Concerns regarding increased insurance costs have also shown to be minimal. Expanding insurance coverage for biomarker testing is projected to increase premiums by only $0.08 to $0.51 per member per month, according to a 2022 analysis by Milliman. The same study found the average allowed cost per biomarker test ranges from $78.71 for Medicaid to $224.40 for large group self-insured plans, while patients without coverage can face hundreds or even thousands of dollars in out-of-pocket expenses.
If passed, Tennessee would join states that have enacted similar legislation, including Kentucky, Oklahoma, Arkansas, Texas, Indiana and Florida.
The legislation is supported by the American Cancer Society Cancer Action Network, the Alzheimer’s Association, the Tennessee Medical Association, End Preeclampsia, Tennessee Men’s Health Network, Arthritis Foundation, ALS Association, Michael J. Fox Foundation for Parkinson’s Research and Lupus and Allied Diseases Association and Tennessee Oncology.
House Bill 0484/Senate Bill 0435 is expected to be considered by the Insurance Subcommittee on February 5. If passed, the bill would take effect July 1.