AZ| Arizona DIFI’s Regulatory Bulletin 2026-01 (INS) reiterates that, beginning in 2023, Arizona law requires specified health insurers to cover biomarker testing when the test provides clinical utility for diagnosis, treatment, appropriate management, or ongoing monitoring, as demonstrated by medical and scientific evidence, and clarifies that insurers’ policies, guidelines, and utilization review tools must be updated to align with statutory standards and cannot impose additional or conflicting criteria.
- Policy forms and internal manuals must clearly reflect Arizona’s biomarker law, avoid extra-contractual conditions, and use non-misleading language that accurately describes biomarker coverage and limitations.
- Insurers must cover biomarker tests that meet statutory “clinical utility” requirements, using evidence sources such as FDA labeling, CMS/Medicare coverage determinations, and nationally recognized clinical guidelines
- Insurers may not deny biomarker tests based on outdated or noncompliant utilization review guidelines, or by labeling tests “experimental” without evidence addressing Arizona’s clinical-utility elements.