A few weeks ago, 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 shortly thereafter. Specifically, this bill, House File 1978, and its companion bill, Senate File 1948, would require all state-regulated insurers, including Medicaid and Minnesota Care to cover biomarker testing.
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, MD, 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 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 because 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 white men. 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, prohibits health insurers from discriminating against enrollees based on their genetic information. An actuarial analysis found 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.
My dad was diagnosed with metastatic cancer and didn’t tolerate chemotherapy. Had his insurance covered biomarker testing, he might have received a targeted treatment and still be with us. There are many survivor stories from people who credit biomarker testing with their outcome. We need more of these stories, and you can be part of the momentum. Let’s raise awareness of the need for this bill and the positive impact that it will have. Use the hashtag, #precisionmattersmn, tag your legislators and urge them to support this bill to make Minnesota a healthier and more equitable state for all. Every voice matters.
Aleta Steevens, of North Oaks, is a regulatory specialist for cancer clinical trials in the Masonic Cancer Center. She is also an MPH student at the University of Minnesota School of Public Health. She is working with Emily Myatt, the director of government relations for ACS CAN, as part of the course Legislative Advocacy. Steevens has a PhD in neuroscience from the University of Rochester in New York. Dr. Douglas Yee, MD, director of the Masonic Cancer Center, reviewed and contributed to this piece. Additional editing was performed by Cori Chandler, senior state & local campaigns manager of ACS CAN.
