Imagine this: someone you love has just heard the words “you have cancer.” They are meeting with their oncologist – perhaps even me, or one of my colleagues – and come to understand that there is specialized testing that can help decide what treatments might best target their specific cancer.
The oncologist plans to rely on something called biomarker testing to find a treatment so precise that it targets the specific biology in hopes to keep that cancer from destroying their vital organ functions.
This groundbreaking component of precision medicine looks for biomarkers – molecules like proteins and genetic alterations – that can provide information about a patient’s cancer or other condition. The results can help doctors choose the most effective treatment for an individual patient, and also likely one with fewer side effects. Biomarker testing is essential to high-quality, personalized care for many conditions and can be a real gamechanger for many patients.
Sounds promising, doesn’t it?
Now imagine the doctor sitting across from your loved one has to tell them that, although this specialized testing is available, his or her insurance company will not pay for it.
Unfortunately, this is the reality for many cancer patients covered by state regulated private health insurance plans in Connecticut. Insurance coverage of biomarker testing has not kept pace with the speed of medical innovation, contributing to significant disparities in who is benefiting from biomarker testing and biomarker-informed treatment.
There are significant disparities in health outcomes for Connecticut patients by race, income, and insurance type. And without action to address barriers to care, breakthroughs in personalized treatments could increase these disparities in health outcomes. Already 20 states (including New York, Rhode Island and Vermont) have passed similar laws to increase access to comprehensive biomarker testing, with legislation pending in another nine states. It’s time for Connecticut to do the same.
Despite lawmakers ensuring coverage of biomarker testing for Medicaid recipients during last year’s legislative session, work needs to be done to extend this assurance of coverage to all state-regulated health insurance plans. Thankfully, legislation is being considered that will increase access to biomarker testing by ensuring state-regulated private insurance plans will cover the tests when supported by medical and scientific evidence.
By helping connect the patient with treatment tailored specifically to them, biomarker testing has played a critical role in improving cancer outcomes and has become an essential tool for oncologists to decide the best course of treatment for any individual. It’s telling that 37 of the 62 oncology drugs launched in the past five years require or recommend biomarker testing prior to use.
While most current applications are in cancer, biomarker testing is also becoming increasingly important to the treatment of other disease areas including arthritis, other autoimmune conditions, organ and tissue transplant, rare diseases, and preeclampsia. There is biomarker research happening in many other areas including Alzheimer’s, other neurological conditions, cardiology and more. Current non-oncology biomarker testing applications could be used to address common comorbidities in cancer patients and survivors and as personalized medicine continues to evolve, non-oncology biomarker testing applications will likely have an increasing role in guiding treatment for patients.
It’s worth noting that in late February, Connecticut will mark Rare Disease Day – raising awareness for patients, families and caregivers around the world that are affected by rare disease. But shouldn’t we do more than just acknowledge the burden of rare diseases? We must actively work to improve survival outcomes and quality of life for those living with any serious diagnosis – whether rare disease, or cancer.
Expanding access to biomarker testing will help more people get the right treatment at the right time and avoid therapies that are unnecessary or ineffective for their condition. This is why well over 50 public health and disease groups here in Connecticut have voiced their support for increasing access to biomarker testing for all patients who need it – regardless of what type of insurance they have.
As a radiation oncologist and cancer center director, my patient’s health and wellbeing is my top priority. I know that lawmakers can play a part in this by helping ensure patients with cancer and other serious disease get the right treatment, at the right time, for their specific disease.
Biomarker testing is a vehicle that gets us there. This legislative session, I urge Connecticut lawmakers to ensure that the biomarker testing patients need is covered by all state-regulated insurance plans, public and private.
Andy Salner M.D. practices in Hartford.