RS 1028.3 - Required coverage for genetic testing for cancer
A. The legislature hereby finds that cancer is a leading cause of death in this state. Medical advances in genetic testing for various types of cancer including but not limited to breast, ovarian, colon, thyroid, prostate, pancreatic, lung, melanoma, sarcoma, kidney, and stomach cancers greatly assist in estimating the chance of developing cancer in an individual's lifetime. Genetic testing can help predict the risk of a particular cancer and assist in determining if a patient has genes that may pass increased cancer risks to their children.
B.(1) Any health coverage plan renewed, delivered, or issued for delivery in this state shall include coverage for genetic or molecular testing for cancer including but not limited to tumor mutation testing, next generation sequencing, hereditary germline mutation testing, pharmacogenomic testing, whole exome and genome sequencing, and biomarker testing.
(2) The coverage provided in this Section may be subject to annual deductibles, coinsurance, and copayment provisions as are consistent with those established under the health coverage plan. The coverage provided under this Section may be subject to applicable evidence-based medical necessity criteria under the plan.
C. For purposes of this Section, "health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including group insurance plan, a self-insurance plan, and the office of group benefits programs. "Health coverage plan" shall not include a plan providing coverage for excepted benefits defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.
D. As used in this Section, the following definitions shall apply unless the context indicates otherwise:
(1) "Biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include but are not limited to gene mutations or protein expression.
(2) "Biomarker testing" is the analysis of a patient's tissue, blood, or fluid biospecimen for the presences of a biomarker. Biomarker testing includes but is not limited to single-analyte tests, multi-plex panel tests, and partial or whole genome sequencing.
Acts 2021, No. 43, §1, eff. Jan. 1, 2022.