NJ| New Jersey Department of Banking and Insurance Bulletin No. 26-08, issued October 5, 2026, clarifies insurers’ obligations under P.L. 2025, c. 49 to cover biomarker precision medical testing for diagnosis, treatment, management, or monitoring of diseases or conditions, excluding asymptomatic screening. The law applies to policies and contracts delivered, issued, executed, renewed, or approved for issuance or renewal in New Jersey on or after July 22, 2025. Coverage is required when any one of five specified evidence criteria is satisfied, including applicable FDA indications or drug labeling, Medicare coverage determinations, or nationally recognized clinical practice guidelines. Carriers cannot impose additional or different coverage criteria and must apply the least-restrictive criteria when multiple qualifying standards apply.
- Medical policies must reflect the law and expressly recognize its precedence over general multijurisdictional requirements.
- When none of the five criteria applies, carriers may evaluate testing using their judgment, medical policies, and available evidence.
- Utilization review must follow statutory timelines; denials must include clear appeal information. Noncompliance may trigger enforcement.