New Jersey Now Requires Health Plans to Cover Essential Biomarker Testing

In a move to make cutting-edge medical care more accessible, New Jersey has enacted a law requiring health insurers to cover biomarker testing. Signed into law on April 23, 2025, the legislation ensures that state-regulated health plans, Medicaid, and public employee benefit programs pay for these tests when they are backed by scientific evidence. For patients facing diseases like cancer or Alzheimer’s, this could mean faster diagnoses and treatments tailored to their unique biology.

Biomarker testing analyzes biological indicators, such as genes or proteins, to reveal critical details about a patient’s health. These insights guide doctors in crafting precise treatment plans, often improving outcomes and quality of life. The law targets conditions where personalized medicine is making strides, including oncology, neurology, and rare diseases, offering hope to thousands of residents grappling with complex illnesses.

The science behind biomarker testing is transforming healthcare. By identifying specific traits of a disease, such as genetic mutations in a tumor, doctors can select therapies that target those traits directly. For example, in lung cancer, tests can pinpoint mutations that respond to newly approved drugs, potentially extending lives. In Alzheimer’s, early biomarker testing can confirm diagnoses and connect patients to therapies that slow disease progression, a critical need for the 185,000 New Jerseyans over 65 living with the condition.

Patients have shared powerful stories illustrating the stakes. One cancer survivor credited biomarker testing with guiding her life-saving treatment, allowing her to see her children grow. Her cousin, diagnosed with pancreatic cancer but unable to access the same testing, passed away. Such disparities highlight why advocates pushed for the law, arguing that financial barriers should not block access to potentially transformative care.

The new law, known as A4163/S3098, mandates coverage for biomarker testing when it is FDA-approved, tied to an approved therapy, or recognized by Medicare coverage decisions. This ensures that only evidence-based tests qualify, balancing innovation with accountability. Sponsored by lawmakers like Senators Vin Gopal and Troy Singleton, and Assembly members Shavonda Sumter, Gary Schaer, and Shama Haider, the legislation won broad support from patient advocacy groups and healthcare providers.

New Jersey is not alone in this effort. At least 20 other states, including California, Texas, and Illinois, have passed similar laws, reflecting a national push to integrate precision medicine into standard care. Yet coverage remains uneven across the U.S., with some states lacking mandates and others leaving Medicaid beneficiaries with limited access. In New Jersey, the law aims to level the playing field, ensuring that all residents, regardless of income, can benefit from these advances.

Supporters of the law emphasize its potential to save lives and reduce long-term costs. By enabling earlier, more accurate diagnoses, biomarker testing can prevent costly complications and ineffective treatments. For diseases like multiple sclerosis, emerging tests could predict disease activity, allowing doctors to adjust treatments proactively. Advocacy groups, including those representing lung cancer and Alzheimer’s patients, hailed the law as a lifeline for families facing devastating diagnoses.

However, some policymakers and analysts raise concerns about the financial impact. Requiring insurers to cover advanced diagnostics could drive up premiums, a worry in a state where healthcare costs are already high. Critics argue that market-driven solutions, like consumer choice in insurance plans or incentives for cost-effective care, might better balance affordability and access. They point to alternatives, such as health savings accounts or deregulated insurance markets, as ways to encourage innovation without mandates.

New Jersey’s law arrives amid broader challenges in U.S. healthcare. Affordability is a growing concern, with 35% of Americans reporting they cannot access quality care when needed. Racial and ethnic minorities, along with low-income households, face the steepest barriers. While the uninsured rate is at a historic low of under 8%, thanks to federal reforms, high out-of-pocket costs still deter many from seeking care. For biomarker testing, which can cost over $10,000 without coverage, mandates like New Jersey’s are seen as a critical step toward equity.

Nationally, precision medicine is gaining ground. Advances in technologies like single-cell sequencing and AI are expanding the possibilities for targeted therapies, not just in cancer but also in cardiovascular and neurological diseases. Yet disparities in access persist, particularly in states without coverage mandates. New Jersey’s law is part of a trend toward addressing these gaps, with states increasingly using insurance regulations to ensure that cutting-edge care reaches all communities.

As New Jersey implements its biomarker testing mandate, the focus will shift to measuring its impact. Will patients see faster diagnoses and better outcomes? Will healthcare costs stabilize as targeted therapies reduce the need for prolonged treatments? These questions will shape the law’s legacy and influence other states considering similar measures. For now, the legislation offers a tangible step toward making personalized medicine a reality for more residents.

The debate over how best to deliver healthcare continues, with New Jersey’s approach reflecting a belief that targeted regulations can drive progress. Whether through mandates or market reforms, the goal remains the same: ensuring that no one faces a life-altering illness without access to the tools that could make a difference. For patients and families, that promise carries weight far beyond policy debates.