State lawmakers won’t require insurers to cover tests cancer survivors say are crucial

In the summer of 2021, Allanda Christenson discovered a lump on her breast. Three weeks later, she was diagnosed with breast cancer. 

“That’s when things get real — when you get that diagnosis. I almost think of it like — you know that tennis ball machine that spits out balls?” she said, mimicking what it’s like to be overwhelmed by a ball launcher. 

“That’s kind of how you feel in the early stages of the journey,” she said. 

There’s a lot of testing involved when patients have breast cancer, and it all has to happen before treatment can begin so doctors have the information they need, Christenson said. One of the tests she underwent is called biomarker testing. 

Biomarker testing is a way to look for genes, proteins and other substances that provide doctors with details about a person’s cancer, allowing doctors to create targeted treatments. Sometimes, biomarkers will reveal information that helps patients avoid more general treatments, like chemotherapy.  

Christenson’s “excellent insurance” covered almost all of her tests — except her biomarker test, which was deemed “medically unnecessary.” That test cost her $300. 

“That’s not that much for me, but for someone else, that could be a barrier,” Christenson said. “It could delay treatment.”

In January, Christenson testified in front of state legislators in support of a bipartisan effort to require insurance companies to cover biomarker testing for cancer and other diseases. 

It’s the American Cancer Society Cancer Action Network’s only priority for Washington lawmakers during this year’s legislative session, and patients who testified in support of the legislation said biomarker testing may have saved their lives. 

But House Bill 1450 failed to advance this year, marking the second time the Legislature has considered the bill and failed to pass it. Matt Helder, the Cancer Action Network’s government relations director, said he’s just as confused as anyone else as to why it hasn’t passed. 

“We seem to be the only state having a significant problem implementing this policy,” Helder said.

‘The law often lags far behind’

Biomarker testing can help predict a drug’s efficacy, whether patients will respond to treatment and whether disease will recur, Katie Kolan, a lobbyist for the Washington State Medical Oncology Society, told lawmakers during a January committee hearing. 

These tests aren’t considered cutting-edge technology anymore. They’re now the standard-of-care in oncology, Kolan said. A study from 2021 found 60% of all cancer drugs approved in the five years before the study was published require or recommend biomarker testing before use. 

“The law often lags far behind the advancement of medicine,” Kolan told lawmakers. 

The average cost of a biomarker test is $1,700, according to the National Conference of State Legislatures. About 55% of Washington residents with commercial insurance plans aren’t fully covered for biomarker tests, according to a study published in the Journal of Personalized Medicine. 

Robin Sparks, an advocate who has non-Hodgkin lymphoma, said it was dumb luck that the private insurance she picked after retirement covered biomarker testing. 

“Who gets an insurance policy and says ‘I better get that cancer stuff?’” Sparks said. “Me, I was like, ‘I’m not going to get cancer. Nobody in my family has cancer.’ Ironically, that year — 2022 — I was the first of three siblings to have been diagnosed with cancer.” 

“All three of us had biomarker testing,” Sparks added. 

Obstacles to passing

Last year, insurance companies opposed the bill because it would cover all forms of biomarker testing, not just for cancer. The bill was eventually narrowed to only cover cancer patients. 

This year, Rep. Monica Stonier, D-Vancouver, re-introduced the broader bill after conversations began over the ways biomarker testing can benefit people with all sorts of conditions. 

An advocate to end preeclampsia, a blood pressure condition during pregnancy, told lawmakers a biomarker test for the condition was approved in May 2023. Another advocate with the ALS Association said biomarker testing is crucial to preventing severe illness for patients with the neurodegenerative disease. 

Biomarker tests are also used for common conditions such as diabetes and osteoporosis. 

However, Helder, of the American Cancer Society Cancer Action Network, said the main opposition to the bill came from the state Health Care Authority. 

A spokesperson for the Health Care Authority said the legislation includes a “very broad swath of diagnostic tests,” adding that there are tests that “do not perform well for specific conditions, do not change medical management or improve health outcomes, or result in inaccurate diagnoses.” 

Stonier’s bill specifically requires both public and private health care plans to provide coverage for biomarker testing “when supported by medical and scientific evidence.” 

But the Health Care Authority spokesperson said “proposed guardrails in the legislation are insufficient, especially since the [U.S. Food and Drug Administration] itself has stated that their agency’s oversight over this area needs improvement.” 

Stonier said she was surprised to see how far the bill advanced this year because of the estimated cost increase to insurance plans to include biomarker testing. 

“We believe it saves costs to the health care system over time,” Stonier said, adding that she’s optimistic for the bill’s chances next year. 

Fourteen states have passed similar legislation. Helder said the legislation crosses ideological lines and often passes unanimously. 

Jennifer Ziegler, a lobbyist for the Association of Washington Health Care Plans, an insurance industry trade group, told lawmakers the bill would drive up health care premiums.

One study found similar legislation increased insurance costs by around 14 to 51 cents per member. Other research suggests biomarker testing reduces overall cost of care for cancer patients.

Christenson and Sparks believe passing House Bill 1450 would save lives. 

Christenson is now in remission. She says that she hopes to stay cancer-free forever and that biomarker testing is a big reason that’s a possibility. Sparks’ cancer is incurable. But biomarker testing means she can still treat the disease and it gives her a better shot at survival and remission, she said. 

“All of us at some part in our lives are going to have a relationship with cancer,” said Sparks, who founded the C-Suite Center for Hope in Marysville to help cancer patients navigate treatment. “Either ourselves, our family or friends. I have found that to be true.”