Robert (Bob) R. Hearn, Member of the Firm in the Health Care & Life Sciences and Litigation & Business Disputes practices, in the firm’s Tampa and St. Petersburg offices, was quoted in Health Payer Specialist, in “Concerns Mount as More States Adopt Biomarker Laws,” by Rachel Dalloo. (Read the full version – subscription required.)
Following is an excerpt:
More than a dozen states across the country have enacted legislation requiring payers start covering the expensive biomarker testing used in cancer and other specialty treatments.
More may be on the way.
Biomarker tests, which are also called genomic tests, are used to help oncologists determine which drug regimen or other treatment would be appropriate for each specific case of cancer. More than half of the oncology drugs introduced in the past five years require biomarker testing prior to their use.
Aside from treating cancer-related illnesses, the tests also play a role in combating diseases such as arthritis and diabetes. …
The changing legal landscape does give payers discretion. “The laws by and large don’t just say you have to cover any biomarker testing that anybody in the universe comes up with – it has to be legitimate. There are parameters and criteria for what constitutes a medically necessary test,” said Robert Hearn, an attorney for health care & life sciences at Epstein Becker Green.