OK| The Oklahoma Insurance Department Bulletin 2025-06 outlines the mandatory coverage requirements for biomarker testing by all health insurance companies and plans in Oklahoma, pursuant to the Biomarker Law (36 O.S. 6060.5a), effective January 1, 2024. The bulletin clarifies that coverage must be provided for biomarker tests used in diagnosis, treatment, or monitoring when these tests demonstrate clinical utility according to medical or scientific evidence, including FDA approvals and nationally recognized guidelines. Insurers cannot impose additional or more restrictive criteria beyond those specified in the law and must always apply the least restrictive coverage criteria when multiple categories are met.
Key Issues:
- Coverage is required for biomarker testing used for diagnosis, treatment decisions, management, or ongoing monitoring, based on clinical utility as established by medical and scientific evidence, including FDA and Medicare guidelines.
- Insurers are prohibited from adding extra criteria beyond the law; if multiple standards exist, they must use the least restrictive one, ensuring minimum disruption to patient care.
- Medical policies must explicitly reference and comply with the Biomarker Law, and its coverage requirements take precedence over general or conflicting insurance policy standards.