Bill would require insurance to approve testing that personalizes cancer treatments

After year and a half of lobbying, bill is headed to Governor Abbott’s desk

Three years ago, Ashlynn Gomez was diagnosed with breast cancer at just 23 years old.

“I noticed I had a red dot on my right breast. At that point, they said it was stage 2,” Gomez said.

When given few to no treatment options, she switched to an oncology team at MD Anderson in Houston.

They did biomarker testing, which is done for cancer patients to specify what treatment would best suit them.

The type of test is different for each patient’s tumor. Testing can involve a simple blood draw or more expansive genomic sequencing.

Either way, the results show what specific therapy will work best for each patient, so no time is lost.

“They found out I had another tumor behind my first tumor, so it was basically hidden. It went from stage 2 to stage 3 triple negative breast cancer,” Gomez said.

That information made it clear to Gomez’s doctors that regular chemotherapy alone would not work for her.

So they got her into a trial with specialized treatment, followed by regular chemo, which ended up saving her life.

“It’s a personalized treatment. I don’t have to play these guessing games with my life,” Gomez said.

The problem is insurance doesn’t always cover biomarker testing.

“66% of oncologists are telling us that there’s inconsistency in terms of reimbursement from insurance companies,” said James Gray, the Texas Government Relations director for the American Cancer Society Cancer Action Network (ACS CAN).

In fact, it was so inconsistent that ACS CAN decided laws needed to be changed.

“If they don’t know that a biomarker is going to be covered by the insurance company, it’s likely they won’t pursue biomarker testing. So this kind of legislation kind of levels that playing field and assures that Texas cancer patients are covered for biomarker testing. So that decision doesn’t become a financial decision anymore,” Gray said.

For the past year and a half, Gray oversaw teams of volunteers to lobby for mandatory insurance coverage of biomarker testing.

On Monday, Senate Bill 989 passed the House and is headed to Governor Greg Abbott’s desk.

“It makes it very clear that biomarker testing will be covered by state insurance companies,” Gray said.

Gray said this changes the game when making sure cancer does not return. Biomarker testing can be done more regularly, even after remission.

“We can tell through biomarker testing much earlier that cancer has come back and that really changes the course of treatment for that individual,” Gray said.

The bill’s movement was a moment of joy for Gomez, who rallied hard alongside other patients, survivors and family members.

“We worked tirelessly. Sending emails, going to Advocacy Day. Texas needs better health care. They need this biomarker testing,” she said.

If Governor Abbott signs the legislation into law, it will go into effect September 1.

About the Authors:

Courtney Friedman anchors KSAT’s weekend evening shows and reports during the week. Her ongoing Loving in Fear series confronts Bexar County’s domestic violence epidemic. She joined KSAT in 2014 and is proud to call the SA and South Texas community home. She came to San Antonio from KYTX CBS 19 in Tyler, where she also anchored & reported.