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H 1227

An Act relative to patient access to biomarker testing to provide appropriate therapy

194th Legislature (2025-2026) Introduced by Jim Arciero and 60 co-sponsors

Massachusetts bill requiring insurers to cover biomarker cancer testing without prior authorization to expedite patient access to targeted therapy treatment decisions.

Hearing rescheduled to 04/29/2025 from 10:00 AM-01:00 PM in A-2 and Virtual Hearing updated to New End Time
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Bill Summary · H 1227

Legislative bill overview

H 1227 requires health insurers in Massachusetts to cover biomarker testing without prior authorization requirements when ordered by a healthcare provider to determine appropriate cancer treatment. The bill aims to eliminate insurance barriers that delay patients' access to genetic and molecular testing that identifies which therapies will be most effective for their specific cancer type.

Why is this important

Biomarker testing can significantly improve cancer treatment outcomes by matching patients with targeted therapies, but insurance delays for prior authorization can postpone critical treatment decisions. The bill addresses a real-world problem where patients experience treatment delays while waiting for insurance approval of diagnostic tests their doctors deem medically necessary.

Potential points of contention

  • Cost concerns: Insurers may resist mandatory coverage without prior authorization due to concerns about increased testing costs and potential overutilization of expensive biomarker panels
  • Definition scope: Disagreement over which specific biomarker tests qualify for mandatory coverage and whether the definition is too broad or too narrow
  • Prior authorization trade-offs: Tension between eliminating delays (patient advocacy view) and maintaining some insurance review process to ensure appropriate test selection and cost control

Compiled from official sources — confirm details with the bill’s official record.

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