by Jill Nolin, Georgia Recorder [This article first appeared in the Georgia Recorder, republished with permission]
February 14, 2023
Jaymie Knox didn’t even know what biomarker testing was before it was done as part of a biopsy of her lung.
But after it helped pinpoint the type of cancer she has – stage-four ALK-positive lung cancer – and the exact treatment she needs to keep it at bay, she wants everyone who would benefit from this diagnostic testing to be able to get it.
“I didn’t know it was a thing,” Knox said in an interview. “When you hear ‘cancer’ you automatically think chemo and radiation. You don’t know there are all these different and new and innovative treatments and ways to work with it that weren’t there before.”
“It was just done,” she said of the biomarker testing. “And I was really, really grateful for it.”
The 36-year-old Savannah resident stays active. She works out every day – and has taken 300 high-intensity cardio classes at a local gym – and works as a service manager in the facilities industry while running her own media company, WJMS media.
Knox was living in New York when she was first diagnosed with lung cancer in 2018, and she received the biomarker testing at an academic medical center there.
Now, she’s part of a push to require health insurance plans to cover comprehensive biomarker testing for Georgians who may not have access to it today. She recently traveled to Atlanta to make the case for a bill sponsored by Marietta Republican state Rep. Sharon Cooper, who chairs the House Public Health Committee.
Four other states – Arizona, Illinois, Louisiana and Rhode Island – have passed similar measures. Georgia is one of 17 states where legislation expanding access to biomarker testing is expected this year, according to the American Cancer Society Cancer Action Network.
“If I hadn’t had biomarker testing myself, I wouldn’t be here today,” Knox said. She said her advocacy is about “making sure people have the same chances that I do to survive and to grab cancer and say no this is not going to be the end of my story.”
Cooper’s bill has already cleared the House Insurance Committee in this year’s slow-paced legislative session, and it has the backing of a coalition that includes nearly four dozen organizations. It has until March 6 to clear the full chamber to have the best shot at becoming law this year.
The longtime lawmaker argues that her bill would ease patient suffering and save valuable time and money if ineffective or unnecessary treatments are avoided. The testing is also used when diagnosing autoimmune diseases.
Proponents say that access to biomarker testing is uneven in Georgia.
“Many of the places in the state are doing it,” Cooper told a House panel recently. “Our Medicaid system already does it. But the carriers in Georgia – about 54% of them – were using this. All Georgians have – not a right – but should be afforded this new and innovative approach to getting the right medicine to the right person.”
Cooper batted away proposed amendments from a lobbyist who represents the state’s commercial health insurers that would have limited the bill to cancer diagnoses and to situations where the testing was deemed “medically necessary.”
“Our concern is does this broadly written bill open the door for things that are not supported by medical or clinical evidence to be performed on a patient?” said Jesse Weathington, president and CEO of the Georgia Association of Health Plans. “We want the right person to get the right care at the right time. We probably disagree about exactly how that needs to be.”
The bill does spell out that the testing should be covered when supported by medical and scientific evidence, such as nationally recognized clinical practice guidelines.
Cooper argues physicians will not be using the testing “willy-nilly,” and said biomarker testing could soon prove useful in treating other conditions, like Alzheimer’s.
She said the decision should not be left to insurers on whether the testing should be covered.
“I know how the insurance companies work, and I think putting the word necessity in there gives them more leeway to do denials,” Cooper said.
Proponents say requiring robust coverage of biomarker testing could increase monthly premiums by as little as 8 cents or as much as 51 cents per person, according to an analysis commissioned by the American Cancer Society Cancer Action Network.
The projected increase does not factor in potential savings due to more effective care, said Julie Vojtech, the nonprofit’s government relations director in Georgia.
“That is such a tiny increase. Who wouldn’t pay an additional 50 cents per month on your premiums if it might bring back the person you loved?” she said. “If I could have my dad, my best friend back by paying a mere 50 cents a month, who wouldn’t do that?”
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