A bill inching through the Tennessee Legislature could shift hundreds or even thousands of dollars in medical costs off patients and onto insurers, supporters say. The proposal would require TennCare and private health plans to cover biomarker testing for people who already have diagnosed illnesses. These tests, which can include extensive blood work, genomic sequencing and imaging, often run from several hundred to several thousand dollars out of pocket. Nashville professor and breast cancer patient Dr. Beth Madison has emerged as one of the most visible advocates for the measure.
What the bill would do
The proposal appears in the Legislature as HB 484 in the House and SB 435 in the Senate. As written, it would require health benefit plans that are issued, amended, or renewed on or after January 1, 2026, to cover biomarker testing for diagnosis, treatment, appropriate management or ongoing monitoring when the testing is backed by medical and scientific evidence, according to the Tennessee General Assembly.
The House version, HB 484, was filed by Rep. Brock Martin (R-Huntingdon), who has promoted the bill as a way to expand access to targeted cancer care, according to the House Republican Caucus. The legislation defines biomarker testing broadly, covering everything from single-analyte panels to whole-genome sequencing. It also spells out one clear limit, stating that insurers would not be required to cover biomarker tests used to screen people who have no symptoms.
Patient voices driving the push
Madison, who is currently in treatment for breast cancer, told WSMV that biomarker testing helped her doctors zero in on a triple-positive, fast-growing tumor so they could tailor her care. “With breast cancer or any time you have cancer, you need to know as much about your enemy as you can,” she said.
She has also said earlier that biomarker screening played a role in slowing the progression of her autoimmune conditions. Madison has been making the trip to the Capitol to share those experiences directly with lawmakers and to urge them to pass the bill.
Advocacy and the national picture
The American Cancer Society Cancer Action Network has made biomarker coverage a priority in Tennessee and points out that 20 other states have already enacted similar laws that require coverage, according to ACS CAN. Earlier this year, local organizations and more than 50 advocates, including patients and survivors, gathered at the state Capitol to push for the change, WDEF reported.
Cost and fiscal outlook
The Legislature’s Fiscal Review Committee projects that the bill would increase state expenditures by about $1.47 million in fiscal year 2025-26 and roughly $2.93 million in each year after that, according to its fiscal memorandum. Despite the higher state costs, the analysis suggests any increase in individual insurance premiums would probably stay under one percent.
The same review notes that average reimbursements for certain biomarker tests were about $272 per test between 2021 and 2023, with some state health plans paying higher averages. Those figures help explain why patients currently can feel serious sticker shock when they get the bill.
How coverage would work
The bill instructs insurers to provide coverage in a way that minimizes disruptions in patients’ care and preserves existing utilization review tools. At the same time, it sets clear clocks for prior-authorization decisions: 72 hours for non-urgent requests and 24 hours for urgent ones, according to the bill text. Insurers would also have to post straightforward exception and appeal procedures on publicly accessible websites.
Supporters say those rules are designed to keep patients from getting stuck in red tape when biomarker tests identify an actionable result and a targeted treatment is available.
What’s next at the Capitol
Backers of the proposal say it could land in House and Senate subcommittee hearings “as early as next week,” and advocates are preparing to keep pressing lawmakers during those meetings, according to WSMV. If the legislation passes in its current form, the new coverage requirement would kick in for health plans issued or renewed on or after January 1, 2026.
