LUGPA Policy Brief: State Momentum Builds on Biomarker Testing Coverage
April 2026
At-a-Glance Essentials
What’s Changing
States are advancing legislation to require Medicaid coverage of biomarker testing when medically appropriate.
Why It Matters
Biomarker testing is foundational to precision medicine, yet Medicaid coverage gaps continue to limit access and drive disparities in care.
Key Development
New Hampshire SB 606 passed the Senate with amendments that may weaken access; now under House review.
Overview
State policymakers are increasingly prioritizing biomarker testing as a standard component of modern, evidence-based care. By using genetic and molecular data to guide clinical decision-making, biomarker testing enables more precise treatment selection, reduces trial-and-error prescribing, and can help avoid unnecessary or ineffective interventions—improving outcomes while supporting more efficient healthcare spending.
Coverage Gaps Persist—Especially in Medicaid
Despite broad clinical adoption, access to biomarker testing remains uneven. Medicaid beneficiaries are significantly less likely to receive recommended testing compared to commercially insured patients, contributing to disparities in diagnosis, treatment selection, and outcomes. Inconsistent coverage policies, prior authorization requirements, and narrow definitions of “medical necessity” continue to limit uptake.
New Hampshire SB 606: A 2026 Test Case
SB 606 is intended to establish Medicaid coverage for biomarker testing across diagnosis, treatment selection, and disease management, aligned with nationally recognized, evidence-based clinical guidelines.
Status: Passed the Senate (March 13, 2026); currently under consideration in the House.
LUGPA Concerns with Senate Amendments:
• Clinical Utility Standard: Allows the state Medicaid agency to independently determine clinical utility rather than deferring to established clinical guidelines and compendia
• Medical Necessity Requirements: Retains language that may enable continued denials and administrative barriers
• Funding Contingency: Includes a “sufficient funding” clause that could delay or limit implementation, undermining the bill’s intent
Broader State Momentum
More than 20 states have enacted biomarker testing coverage requirements across Medicaid or commercial markets, often with strong bipartisan support. Many laws tie coverage to nationally recognized guidelines (e.g., NCCN, ASCO), helping ensure appropriate use while minimizing administrative burden. These policies reflect a growing consensus that biomarker testing is the standard of care in oncology and increasingly relevant across other disease areas.
Implications for Urology
Biomarker testing is playing an expanding role in urologic oncology, particularly in prostate, bladder, and kidney cancers, where it informs risk stratification, treatment selection, and disease monitoring. Ensuring consistent, guideline-aligned coverage is critical to delivering high-quality, personalized care.
Bottom Line
Momentum is building at the state level to expand access to biomarker testing—but policy design will determine impact. LUGPA supports clear, guideline-driven coverage frameworks that ensure Medicaid patients can access medically appropriate testing without unnecessary administrative or financial barriers.
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