Certain health insurance policies and some self-funded employee benefit plans must cover biomarker testing starting January 1, 2028, with exceptions for specified disease or limited-benefit coverage.
(1) On and after January 1, 2028, and notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage and (b) any self-funded employee benefit plan to the extent not preempted by federal law, shall include coverage for biomarker testing pursuant to the criteria established under subsection (2) of this section. (2) Biomarker testing shall be covered when: (a) The test is used for: (i) The diagnosis, treatment, appropriate management, or ongoing monitoring of cancer, an autoimmune or autoinflammatory disease, Parkinson's disease, amyotrophic lateral sclerosis, Alzheimer's disease and related dementias, rheumatoid arthritis, preeclampsia, sickle cell anemia, or a cardiovascular condition; (ii) An organ or tissue transplant; or (iii) Pharmacogenomic testing; and (b) The test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to: (i) Labeled indications for a test approved or cleared by the federal Food and Drug Administration; (ii) Indicated tests for a drug approved by the federal Food and Drug Administration; (iii) Warnings and precautions on drug labels approved by the federal Food and Drug Administration; (iv) National coverage determinations by the federal Centers for Medicare and Medicaid Services or local coverage determinations by the medicare administrative contractor; or (v) Nationally recognized clinical practice guidelines and consensus statements. (3) Coverage, as specified in subsection (2) of this section, shall be provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples. (4) The patient and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy. The process shall be made readily accessible on the health carrier's website. History: Laws 2025, LB77, § 15.