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New Georgia law requires biomarker testing to be covered under insurance | Here's what it means

Advocates say biomarker testing allows for more precision diagnoses and treatments to diseases like cancer.

ATLANTA — A new law could help cancer patients save thousands of dollars. The law would require health insurers to cover biomarker testing. 

Jaymie Knox knows firsthand how impactful biomarker testing can be. Knox's life changed forever in December 2018. The gym-goer and kickboxer, who now lives in Savannah, got the gut punch she never expected. 

"I think I was in shock. I was in disbelief," Knox said. "I’m a nonsmoker and I have no history of cancer in my family. This diagnosis came out of left field and knocked me on my butt.”

What started out as an occasional cough, wheeze and bouts of shortness of breath turned into a diagnosis of stage four Alk-positive lung cancer. She said doctors had to drain two-and-a-half liters of fluid from her lungs. 

“It reminds you of your mortality, Knox said. "We all walk around this life thinking we’re immortal on some level. We take a lot of things for granted.”

Credit: Provided
Jaymie Knox

Knox credits biomarker testing with returning normalcy to her life. Biomarker testing checks a patient's blood or tissue, giving doctors a better chance of matching the patient's condition with an effective treatment. It's been around for about 15 years. 

“With targeted therapy, what happens is that medication is like a sniper," Knox said. "It’s specifically designed to only target the cancer cells in your body that are mutating. Your side effects are way less severe, way more manageable, and it gives you a better quality of life.”

Julie Vojtech, the government relations director for the Georgia Chapter of the American Cancer Society Cancer Action Network, said biomarker testing has increased patient survival rates 31 percent.

“It’s going to save lives, it’s going to save money," Vojtech said. "It’s innovative, and this is the future of healthcare. It really puts Georgia at the forefront of innovative healthcare.”

On Tuesday, Gov. Brian Kemp signed HB85, which expands access to biomarker testing by requiring insurance coverage when there's medical and scientific evidence to support a biomarker test. Vojtech said any doctor can order such a test. 

“If a patient has to try a treatment that’s ineffective, treatments can be very expensive," Vojtech said. "In the meantime, the cancer is growing. Insurance companies don’t always want to cover things unless they have to. About half of insurers were covering it. But what this bill does is it requires insurance coverage when there’s medical and scientific evidence to support biomarker testing." 

Already, several other states have adopted or are considering similar laws. Opponents of the law said biomarker testing should be restricted only to cancer cases and that requiring coverage from health insurers strips power from them. Biomarker testing is also being used in some cases of rheumatoid arthritis, some autoimmune diseases, and some rare diseases, according to Vojtech. 

Knox said experimenting with other treatments that may or may not work would have cost her thousands of dollars. She said her medication cost her $15,000 per month and noted she and others would never be able to afford lifesaving treatment without insurance coverage. She hopes her story is able to educate others by raising awareness about a potentially lifesaving resource. 

“With this law, more people are going to have access to this testing that could potentially change and save their lives," Knox said. "In some weird way, I feel like I’m paying my blessing forward.”

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