Health care coverage: genetic biomarker testing.
The bill seeks to enhance patient access to crucial cancer diagnostics, which can be pivotal in determining effective treatment options. By eliminating the prior authorization requirement, the bill aligns cancer care with current medical practices that emphasize the need for timely interventions. This aligns with the existing mandates that ensure coverage for cancer screening tests and extends protections for patients with advanced cancer, thereby potentially improving patient outcomes.
Assembly Bill 2640, introduced by Assembly Member Gonzalez, amends the Health and Safety Code as well as the Insurance Code to address health care coverage related to genetic biomarker testing. The bill specifically prohibits health care service plans and health insurance policies from requiring prior authorization for genetic biomarker testing for enrollees diagnosed with metastatic or advanced stage 3 or 4 cancer starting January 1, 2021. This change is significant because it aims to streamline the process for patients needing these critical tests without facing hurdles associated with prior authorization, which can delay diagnosis and treatment.
Despite its intended benefits, AB 2640 may raise concerns among some stakeholders regarding the implications for insurance costs and provider practices. Opponents may argue that removing prior authorization requirements for genetic testing could lead to increased use of these expensive tests without adequate oversight, potentially driving up health care costs overall. Furthermore, there may be discussions regarding the unintended consequences for insurance providers and whether they can sustain such mandates without impacting the costs of their services significantly.