Tests to find the right treatment for specific cancers would have to be covered by insurance under a bill recently introduced in the Ohio General Assembly.
House Bill 608 would require biomarker testing to be covered by state-regulated insurance plans, including Medicaid, but only if it meets medical guidelines.
Biomarkers are signs of disease or genetic mutation that can be spotted in blood or tissue. Tests have been developed to use biomarkers in cancer treatment, identifying treatments specifically effective for types of cancer.
“It’s amazing, because the drugs that have been developed just target the cancer cells,” state Rep. Andrea White, R-Kettering, said. That can reduce pain and suffering, save on less-effective treatments, and cut the time people are off work, she said.
White and state Rep. Tom West, D-Canton, introduced HB 608 on March 29. It was referred to the House Insurance Committee but has not yet had a hearing. The bill is based on national model legislation that has passed or is being considered in several states, White said.
“I talked with the American Cancer Society Cancer Action Network about this bill,” she said. White said she is talking to all interested parties to address any concerns about it.
“I think it’s a wonderful bill,” said BethAnn Ennis, who credits biomarker testing with literally saving her life.
Ennis, a Reynoldsburg resident who used to live in Centerville, joined a March 31 rally at the Ohio Statehouse in favor of biomarker testing coverage. There she met White, not knowing she was the bill’s cosponsor, and discovered they had many mutual acquaintances.
Ennis said she had excellent insurance, so her testing cost was covered. But that’s not true for everyone.
The cost of biomarker testing can vary widely depending on the type of cancer. But an average cost is $1,700, according to the National Conference of State Legislatures.
The cost of cancer drugs can be 200 times that, so using biomarker tests to find the most effective treatment can ultimately save on healthcare costs.
Ennis’ story
About five years ago, Ennis went to the hospital with a persistent sharp pain in her side.
“It was there that it was discovered that I had a large tumor growing on my lung,” she said.
Lung cancer is often not found until it’s already advanced, and that was true of Ennis’ case, she said. But unlike most others, her tumor was sufficiently well-contained that surgery was an option. While she awaited that, an oncologist asked if he could have a tissue sample for his own research, which she agreed to.
“He wanted to biomarker test it,” Ennis said. At the time she didn’t even know what that meant, but the oncologist said it might help her later.
Ennis endured traditional chemotherapy and radiation, and learned from the biomarker testing that her lung cancer involved a very rare mutation. The test pointed doctors to specific new drugs.
“It’s kind of like having a gun in your pocket to hold onto when needed,” she said. “For my type of cancer there’s five targeted therapies out there. With biomarker testing, finding that out really saved my life.”
Ennis made it two years without a recurrence.
“But last August, it came back with a vengeance,” she said. Once again, her cancer was advanced when it was found – stage four. But doctors started her on a drug tailored to her specific mutation.
“Within eight weeks, I had no evidence of disease,” Ennis said.
Patients’ longer lives due to such treatments give researchers time to find additional effective therapies, she said.
“So it’s so important that biomarker testing is available to all,” Ennis said.
Many patients outside Ohio’s major cities may not even know how to ask for biomarker testing, and may not have doctors who suggest it, she said.
Costs and benefits
According to the Cancer Action Network, 73,700 Ohioans will be diagnosed with cancer in 2022, and 25,120 will die from it. Ohio’s cancer death rate is higher than the national average, the group says.
Biomarker testing is considered the modern standard of care for several types of cancer, including lung cancer, White said. But it’s not always covered by insurance plans, so many patients don’t receive it, including half of the lung cancer patients who should, she said.
Covering it would have “very minimal” impact on insurance premiums, a few cents per month per person per month, White said.
Thirty-four Ohio cancer and medical groups support the bill, listed as signatories on an April 11 letter to Insurance Committee members.
“Thirty-seven of the 62 oncology drugs launched in the past five years require or recommend biomarker testing prior to use,” the letter says. A recent study found 78% of Ohioans’ insurance coverage is more restrictive than what’s recommended by National Comprehensive Cancer Network, it says. That often prevents patients from getting biomarker testing because the out-of-pocket cost would be high —especially in poorer and more rural communities, according to the letter.
“I learned about this and I said ‘Sign me up, I want to advocate for this bill,’ ” White said.
White said she’s seeking information from Medicaid and other insurers to find out exactly how often biomarker testing is covered in Ohio, and to figure out how much it might save by identifying the most effective treatments.
“Our hope is that the business case is going to be clearly seen,” White said.
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