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Bill

SB 464

Requiring insurance coverage for biomarker testing

2026 Regular Session

West Virginia requires health insurers to cover biomarker testing, expanding access to personalized medicine diagnostics but increasing insurance costs and coverage disputes.

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Bill Summary · SB 464

Legislative bill overview

SB 464 mandates that health insurance plans in West Virginia must cover biomarker testing—molecular tests that identify genetic or protein markers associated with disease risk, treatment response, or prognosis. The bill applies to all insurers offering coverage in the state and requires coverage regardless of whether the test is considered experimental or investigational by some standards.

Why is this important

Biomarker testing can enable personalized medicine by identifying which patients will benefit most from specific treatments, potentially improving outcomes while reducing unnecessary procedures. However, coverage mandates directly increase insurance costs, which may be passed to employers and consumers through higher premiums, and can incentivize testing that may not always be clinically necessary or evidence-based.

Potential points of contention

  • Cost and premiums: Mandatory coverage increases insurer costs, potentially raising premiums for all policyholders, particularly impacting small businesses and individuals in the individual market
  • Clinical evidence standards: The bill's scope regarding which biomarker tests qualify is critical—overly broad definitions could require coverage of tests lacking sufficient clinical validation, while narrow definitions may exclude beneficial emerging tests
  • Insurance company flexibility: Mandates reduce insurers' ability to negotiate prices or establish medical necessity criteria, potentially affecting their competitive positioning and profitability in West Virginia's market

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

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