With every new advance in medicine — from testing to diagnosis to treatment to prescription drugs — comes new hope. But alongside that hope often comes a lingering worry: that skyrocketing costs will price us out of the better health we seek.
The State Legislature tackled two critical pieces of our complex health care puzzle last spring — on insurance coverage for biomarker testing and transparency for prescription drug prices. Both bills now await Gov. Kathy Hochul's signature.
Among the most important medical advances in recent memory is the growth of biomarker testing — the effort to profile a patient's genetic markers and other mutations in an effort to determine paths of treatment and prognosis. Such testing is enormously important in the world of cancer care, but can also be used in the treatment of autoimmune diseases, arthritis and other conditions. By all accounts, biomarker testing is and will continue to be game-changing.
But such testing remains out of reach for too many patients — especially in low-income and minority communities — because their health insurance doesn't cover it. Nearly a third of New Yorkers have health insurance — including Medicaid — that does not universally cover biomarker testing.
Legislation that passed both state houses would require every state-regulated insurance plan, including Medicaid, to cover such testing for the diagnosis, treatment and monitoring of any disease or condition where medical and scientific evidence support it. A dozen states have similar laws on their books. The bill rightly doesn't limit which diseases would be covered. Any effort to narrow the bill to, for instance, just cancer treatment would limit the benefits of biomarker testing. The legislation underwent tweaks, gaining even the support of the New York Health Plan Association, an insurance industry organization. This is a no-brainer — and deserves Hochul's signature.
So does legislation to assure transparency on prescription drug price increases. That bill would require manufacturers of any drug whose wholesale cost stood above $40 to notify the state Department of Financial Services if the cost is going to increase by more than 16%. News of an increase would have to be submitted at least 60 days before it takes effect. Then, DFS would have to post it to its website.
That would give consumers, insurers and others a chance to take steps to mitigate such increases before they happen. It also could impact drug prices themselves; manufacturers might limit increases to avoid the reporting requirements. In Vermont, one of 20 states with similar transparency laws, residents saw a nearly 80% decrease in the number of drugs with price increases of 15% or more. Here, too, there seems to be no downside. Providing more information on drug prices, and giving residents more tools to make better decisions, is laudable.
For the health of all New Yorkers, Hochul should sign both bills.
MEMBERS OF THE EDITORIAL BOARD are experienced journalists who offer reasoned opinions, based on facts, to encourage informed debate about the issues facing our community.