On a recent Friday, Emily Myatt of the American Cancer Society Cancer Action Network (ACS CAN) and I delivered a newly drafted bill to remove barriers to biomarker testing in Minnesota to the Chief Clerk’s office in the State Capitol building, and it was introduced during the legislative session this week. Specifically, this bill, which has bipartisan support, would require that all state-regulated insurers, including Medicaid (medical assistance) and Minnesota Care cover biomarker testing. You might be wondering, “What is biomarker testing and how will this bill impact Minnesotans and improve health equity for our state?”
Biomarker testing is the analysis of a patient’s tissue or blood sample for the presence of a molecular signature that can guide a physician’s treatment plan and assess risk for conditions such as cancer, arthritis, autoimmune diseases, and mental illness, among others. According to Dr. Douglas Yee, the director of the Masonic Cancer Center, testing for alterations in the BRCA gene changed the treatment outlook for breast cancer, in part by predicting which class of drugs may be most effective. The application of biomarker testing to determine who will respond to specific drugs and/or who will have adverse effects is essential to avoiding inappropriate or ineffective treatment. In the case of cancer, this can greatly impact a person’s quality and length of life.
ACS CAN is promoting the bill with the phrase “Biomarker testing connects people to the right treatment at the right time,” and this clever slogan succinctly explains how biomarker testing can be thought of as “precision medicine.” However, it is important to make the following distinction: Biomarker testing is not a screening tool or a commercialized test like 23andme. By contrast, biomarker testing is a well-validated part of medical treatment and helps patients receive the best therapy for their disease. In 2018, more than 55% of clinical trials used biomarker testing, and treatment based on biomarker testing had a better response. To note, the bill language states that insurers are only mandated to cover a biomarker test when it aligns with scientific and medical evidence.
Currently, Minnesotans have unequal access to biomarker testing based on where they live (rural versus the metro area), insurance coverage, and socioeconomic status. People of color – particularly, the Black community – do not benefit from biomarker testing at the same rates as white people. This is particularly concerning, as rates of breast cancer mortality are highest in Black women, and Black men are at a higher risk of mortality from colon and prostate cancer than their white counterparts. No one should have to worry about out-of-pocket costs for this important test. Expanding biomarker testing access will improve justice and health equity.
There are few, if any, drawbacks to this bill. The results of biomarker testing are confidential. Federal legislation, the Genetic Information Nondiscrimination Act (GINA), prohibits health insurers from discriminating against enrollees based on their genetic information. An actuarial analysis found that the increase in health insurance premiums to cover comprehensive biomarker testing would be just cents (between $.05 and $.51) per member per month. Furthermore, when it comes to costs, nothing is more valuable than one’s life.
Aleta Steevens, of North Oaks is a regulatory specialist for cancer clinical trials in the Masonic Cancer Center. She is also an Master’s of Public Health student in the University of Minnesota School of Public Health.
