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Bill

S 4089

Requires health insurance carriers to cover genetic testing after diagnosis of pancreatic cancer.

2026-2027 Regular Session Introduced by Raj Mukherji and 1 co-sponsor

Requires health insurance in NJ to cover genetic testing for patients after a pancreatic cancer diagnosis.

Introduced in the Senate, Referred to Senate Commerce Committee
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Bill Summary · S 4089

Summary of Bill S.4089 (New Jersey, 222nd Legislature)

Overview

  • Title: Requires health insurance carriers to cover genetic testing after diagnosis of pancreatic cancer.
  • Jurisdiction: New Jersey
  • Session: 222
  • Status: Introduced in Senate; referred to Senate Commerce Committee (as of 2026-05-04)
  • Sponsors:
    • Co-sponsors: Joe Vitale, Raj Mukherji

Purpose and Intent

The bill mandates that health insurance carriers operating under New Jersey law cover genetic testing for patients who have been diagnosed with pancreatic cancer. The underlying aim is to ensure patients have access to genetic testing, which can inform personalized treatment options, eligibility for targeted therapies, and familial risk assessment.

Key Provisions (Proposed)

  • Who Must be Covered: Health insurance carriers operating within New Jersey (likely including both fully insured and certain self-insured plans, depending on the bill’s final language) would be required to cover genetic testing for patients diagnosed with pancreatic cancer.
  • Scope of Testing Coverage: The bill specifies coverage for genetic testing recommended as part of standard medical care following a pancreatic cancer diagnosis. This may include germline genetic testing to identify inherited cancer risk and/or somatic/genetic profiling with potential implications for treatment decisions.
  • Financial Considerations: The mandate would require coverage with no or limited out-of-pocket cost to the patient, aligning with typical insurer mandates to cover medically necessary genetic testing without surprise charges (subject to typical policy terms, deductibles, and coinsurance unless otherwise specified).
  • Clinical Indications: Coverage is framed around testing "after diagnosis" of pancreatic cancer, emphasizing tests that have potential clinical benefit in guiding management, prognosis, and familial risk assessment.
  • Standards and Compliance: The bill would likely reference adherence to appropriate clinical guidelines or standards of care for genetic testing in pancreatic cancer, ensuring tests are medically indicated.

Affected Parties

  • Patients with Pancreatic Cancer: Primary beneficiaries who would gain access to genetic testing without financial barriers, enabling personalized treatment decisions and informed family risk.
  • Health Insurers: Carriers would incur additional coverage obligations; the bill would shape benefit design and reimbursement practices for genetic testing.
  • Healthcare Providers: Oncologists, genetic counselors, and multidisciplinary teams would be able to order and counsel patients regarding genetic testing with insurer coverage support.
  • Employers/Plan Sponsors: Particularly for fully insured plans, impacted by mandated coverage requirements.

Procedural and Timeline Aspects

  • Current Status: Introduced in the New Jersey Senate and referred to the Senate Commerce Committee, as of May 4, 2026.
  • Next Steps (typical legislative path): Committee review, potential amendments, floor consideration in the Senate, and, if passed, possible reconciliation with companion bills in the Assembly and onward to the Governor for signature or veto.
  • Effective Date (not specified in provided information): The bill’s effective date would be determined in the final enacted text, typically with a phased-in approach (e.g., immediate upon enactment or after a designated period).

Practical Implications

  • Access and Equity: Aims to reduce financial barriers to genetic testing for pancreatic cancer patients, potentially improving outcomes through personalized therapy selection and enabling at-risk relatives to pursue testing.
  • Cost Impacts: Insurer costs may rise due to broader coverage of genetic testing; the extent would depend on the final language, required test types, and listed indications.
  • Healthcare Quality: Supports alignment with precision medicine trends by integrating genetic information into standard post-diagnosis care.

If you’d like, I can tailor this summary to a specific audience (patients, providers, insurers) or incorporate any finalized text or amendments from the committee amendments once available.

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

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