NEW YORK – New legislation in New Jersey came into effect on Wednesday that requires health insurers to cover biomarker testing that is supported by medical and scientific evidence.
The law affects all state-regulated insurers, including Medicaid, the NJ State Employee Health Benefits Program, and the NJ State Health Benefit Plan. It includes tests for the treatment, management, and monitoring of an individual's disease or condition.
The legislation mandates coverage where the efficacy and appropriateness of a given test is recognized by its approval or clearance by the US Food and Drug Administration, the availability of an FDA-approved drug, and the presence of a Centers for Medicare and Medicaid Services (CMS) national coverage determination or Medicare administrative contractor (MAC) local coverage determination, among other conditions.
With the bill's passage, New Jersey joins 20 other US states that have enacted similar legislation. Proponents of coverage mandates like New Jersey's have argued that these laws are needed to reduce healthcare inequities that often result in minorities, people with limited income, and those in rural settings having little to no access to biomarker testing and to the individualized therapies they can lead to.
"Biomarker precision medical testing helps guide health professionals with more detailed information to diagnose or provide targeted treatment options for diseases, which can lead to improved health outcomes," Justin Zimmerman, New Jersey Department of Banking and Insurance commissioner, said in a statement.
Although experts have been calling for broader laws governing coverage for biomarker testing across the US, the specifics of each state's current laws vary widely, prompting additional calls for greater uniformity in such legislation.
"With this bill now law, we are removing a major obstacle to care and providing New Jersey patients access to essential, evidence-based biomarker testing," said Sen. Vin Gopal, one of the bill's primary sponsors. "No one should be forced to choose between their health and financial struggles. This law will save lives, improve outcomes, and ultimately lower healthcare costs for families across the state."