LUGPA Policy Brief: Expanding Coverage of Biomarker Testing in 2025

May 2025 

Biomarker testing is transforming patient care by enabling precision medicine—matching treatments to a patient’s unique genetic profile. In cancer care, this approach improves outcomes, reduces trial-and-error treatments, and lowers healthcare costs. Yet access to this critical tool remains inconsistent, especially in urology.

Biomarker testing plays an essential role in modern healthcare by:

• Enhancing Treatment Precision: It enables doctors to select therapies that are most likely to be effective, reducing trial-and-error prescribing.
• Improving Survival Rates: Targeted treatments based on biomarker analysis have been shown to extend patient survival and enhance quality of life.
• Reducing Healthcare Costs: By ensuring patients receive the right treatment from the start, biomarker testing can minimize hospitalizations, complications, and ineffective drug prescriptions.
• Identifying Recurrence Risks: It helps predict disease recurrence, allowing for earlier interventions that may improve long-term outcomes.

Despite its benefits, access to biomarker testing is not uniform across patient populations.

Key barriers include:

• Insurance Coverage Limitations: Many commercial insurers and Medicaid plans do not fully cover biomarker testing, particularly for conditions beyond specific cancer types.
• Geographic Disparities: Patients in rural areas and non-academic medical centers often lack access to facilities that perform advanced biomarker testing.
• Socioeconomic Barriers: Individuals from lower-income communities are less likely to receive biomarker testing due to financial constraints and insurance gaps.
• Provider Awareness and Integration: Some healthcare providers are not fully aware of the benefits of biomarker testing or do not routinely integrate it into patient care due to reimbursement concerns.

Several states have taken legislative action to improve access to biomarker testing. Notably, the New Jersey Assembly recently passed Assembly Bill 4163 / Senate Bill 3098, requiring health insurers, including Medicaid, to cover biomarker testing when supported by medical and scientific evidence. This legislation ensures that more New Jersey residents can access precision medicine, potentially improving treatment outcomes and reducing disparities in care.

Similar legislative efforts are gaining momentum nationwide, with states such as California, Illinois, and Arizona considering or implementing policies that expand insurance coverage for biomarker testing. These measures serve as a model for other states looking to ensure equitable access to cutting-edge diagnostic tools.

LUGPA Policy Recommendations

To address disparities and maximize the benefits of biomarker testing, LUGPA advocates for the following policy reforms:

• Mandate Comprehensive Coverage: Require all insurers and Medicaid plans to cover clinically indicated biomarker testing.
• Streamline Testing: Standardize processes to reduce delays and administrative burdens.
• Ensure Coverage Transparency: Allow providers to request exceptions when coverage is unclear.
• Align with Clinical Guidelines: Base decisions on trusted, evidence-based recommendations.
• Expand Access in Underserved Areas: Fund rural testing programs, support telehealth, and promote healthcare partnerships.

Biomarker testing is a cornerstone of precision medicine, offering life-saving benefits for patients while improving healthcare efficiency. However, gaps in insurance coverage, geographic access, and provider awareness continue to limit its widespread adoption.

LUGPA is committed to advocating for policies that expand biomarker testing coverage, streamline testing processes, and ensure that all patients—regardless of location or socioeconomic status—can benefit from these advancements. As legislative activity in this area grows in 2025, LUGPA will continue to champion reforms that enhance patient outcomes and promote equitable healthcare access.