Indiana § 27-8-14.3-10 Coverage for biomarker testing

Indiana Statutes

§ 27-8-14.3-10 — Coverage for biomarker testing

Indiana § 27-8-14.3-10

Title 27INSURANCE

Art. 8LIFE, ACCIDENT, AND HEALTH

Ch. 14.3Coverage for Biomarker Testing

This text of Indiana § 27-8-14.3-10 (Coverage for biomarker testing) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-8-14.3-10 (2026).

Text

(a)A health plan shall provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when biomarker testing is supported by medical and scientific evidence, including:

(1)labeled indications for a test approved or cleared by the United States Food and Drug Administration;

(2)indicated tests for a drug approved by the United States Food and Drug Administration;

(3)a warning or precaution on the label of a drug approved by the United States Food and Drug Administration;

(4)a national coverage determination of the Centers for Medicare and Medicaid Services (CMS);

(5)a local coverage determination of a Medicare administrative contractor; or

(6)nationally recognized clinical practice gu

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(a) A health plan shall provide coverage
for biomarker testing for the purposes of diagnosis, treatment,
appropriate management, or ongoing monitoring of an enrollee's
disease or condition when biomarker testing is supported by medical
and scientific evidence, including:
(1) labeled indications for a test approved or cleared by the
United States Food and Drug Administration;
(2) indicated tests for a drug approved by the United States Food
and Drug Administration;
(3) a warning or precaution on the label of a drug approved by the
United States Food and Drug Administration;
(4) a national coverage determination of the Centers for Medicare
and Medicaid Services (CMS);
(5) a local coverage determination of a Medicare administrative
contractor; or
(6) nationally recognized clinical practice guidelines or consensus
statements.
(b) The coverage required by this section must be provided in a
manner that limits disruptions in care, including the need for multiple
biopsies or biospecimen samples.
(c) Nothing in this section shall be construed to require coverage of
biomarker testing for screening purposes.
(d) If a prior authorization requirement applies to biomarker testing
under a health plan, the health plan or a third party acting on behalf of
the health plan must:
(1) approve or deny a request for prior authorization for
biomarker testing; and
(2) notify the covered individual and any person requesting prior
authorization of the biomarker testing on behalf of the covered
individual;
in not more than five (5) business days after the request in the case of
a nonurgent request or in not more than forty-eight (48) hours after the
request in the case of an urgent request.
(e) A health plan shall ensure that a covered individual and the
practitioner who prescribes biomarker testing for the covered
individual have access to a clear, readily accessible, and convenient
process for requesting an exception to:
(1) a coverage policy; or
(2) a prior authorization determination;
of the health plan that is adverse to the coverage of biomarker testing
for the covered individual. The process required by this subsection
shall be made readily accessible on the health plan's website.