Bill in works for insurers to cover biomarker testing for people with cancer, other diseases


For the Gazette

Published: 05-25-2023 4:34 PM

When she was 13 nearly a decade ago, University of Massachusetts graduate student Maggie Buswick was diagnosed with thyroid cancer. Her doctors informed her that she needed to receive the “highest level” treatment of radioactive iodine, which is a targeted treatment that kills cancerous cells.

The biggest reason medical experts were able to provide that diagnosis, Buswick says, is because they had access to a cutting-edge form of precision medicine known as biomarker testing.

Biomarker testing looks for information from cancer patients’ genes and proteins to identify which treatment would be most effective in combating a specific diagnosis or health condition.

“I’ve found that having biomarker testing really puts my mind at ease, because my doctors will be able to catch any sort of changes in my levels of hormones that I have,” said Buswick, a UMass junior studying sustainability science.

While Buswick is one of the lucky cancer patients who can afford biomarker treatment, many can’t because many health insurance companies, though not all, don’t cover it. That would change if the Legislature approves a bill introduced by Sen. Susan Moran, D-Falmouth, and Rep. Meghan Kilcoyne, D-Clinton, that would require state-regulated insurance plans to cover comprehensive biomarker testing when the need arises and it’s supported by medical evidence.

“I’m privileged to have health insurance that covers biomarker testing that I need,” Buswick said in recent testimony for the bill before the Legislature’s Joint Committee on Financial Services. “I never had to question how I was to pay for it, mostly because I was 13, but also because my parents could afford it. I know that is not true for everyone, but everyone who needs biomarker testing should have access to it.”

Marc Hymovitz, Massachusetts government relations director for the American Cancer Society, Cancer Action Network, said that more patients these days are treated with precision medicine, using targeted therapies that have fewer side effects.

To illustrate how biomarker testing works, Hymovitz explained that if a patient has lung cancer, doctors could tell definitively from a specific biomarker that this patient will respond to “treatment Z.” Without the testing, health practitioners may use “treatment X” and perhaps five weeks of chemotherapy before eventually finding the right treatment. The testing can also help those who have other illnesses such as Lou Gehrig’s disease, arthritis, lupus and others, he noted.

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“The scientific research that we have now can give the patient this biomarker test and get that patient to the right treatment quicker,” he said.

The precision also means less cost to the health care system, Hymovitz said.

At the joint public hearing, Sen. Moran said the bill seeks to ensure Massachusetts residents have access to the medicines, therapies and treatments that can save their lives. “That’s invaluable and it’s an opportunity that biomarker alone can provide,” Moran said.

“Comprehensive biomarker testing can significantly reduce the time and steps it takes for doctors to determine the most effective treatment,” she later added. “It saves money both for the patient and the insurance company, reduces the logistical differences that come with this serious diagnosis, and most importantly puts the patient on the path to recovery as soon as possible.”

Over the past two years, state legislatures in Arizona, California, Illinois, Louisiana, and Rhode Island have passed laws mandating coverage of comprehensive biomarker testing.

For Buswick, the risk of not having biomarker testing was not getting adequate treatment. She recalled that her doctors were originally hesitant on using the highest radioactive iodine treatment due to her age, but because of her biomarkers, they decided it would be the most effective treatment, without risk of recurrence.

In 2021, the American Cancer Society Cancer Action network surveyed 315 oncology providers and 66% reported that insurance coverage for biomarker testing is a significant to moderate barrier.

“We’ve got this great scientific tool but not everybody has access to it — and more often than not that’s because of a lack of insurance coverage,” Hymovitz said.

People with lower socio-conomic status or those who live in rural areas often have little to no access to biomarker testing. With the current legislation, Hymovitz said he is hopeful that this will not only close the insurance gap but also greatly benefit communities of color.

Since this is a “scientific breakthrough,” science is often ahead of policies and the insurance industry, Hymovitz said.

Moran ended her testimony before the committee by urging members to advance the bill.

“The need exists for patients, the tools exist for doctors,” she said. “The only gap that exists is coverage. Let’s take this critical step to bridge that gap and save lives.”

The bill is currently in its first year of the legislative session. The bill was passed on May 2 before the Committee on Financial Services. Buswick promised that she will continue lobbying and advocating for insurance coverage on biomarker testing.

“Health care equity is really important, we’re moving forward and as new technologies begin develop… I really don’t want other kids to have to continue to have experiences like that, or adults for that matter,” Buswick said.

Sydney Ko writes for the Gazette as part of the Boston University Statehouse Program.]]>