KY| The Kentucky Department of Insurance Bulletin 2026-03 explains that, effective for health benefit plans issued, delivered, amended, or renewed on or after January 1, 2024, Kentucky insurers must cover biomarker testing ordered by a qualified provider within their scope of practice when it is used to diagnose, treat, manage, or monitor an insured’s disease or condition and is supported by medical and scientific evidence as outlined in KRS 304.17A-263.
“Biomarker” and “biomarker testing” are broadly defined to include gene mutations, protein expression, single‑analyte tests, multiplex panels, and whole‑genome sequencing, and coverage is deemed appropriate if any one of several statutory evidence standards is met (e.g., FDA labeling, CMS national coverage determinations, MAC local coverage determinations, clinical guidelines, or consensus statements), with the list being non‑exhaustive. Insurers may not impose additional or different coverage criteria beyond these standards, and any denials must be accompanied by a clear, accessible website process for exceptions and appeals, as well as prior authorization procedures that fully comply with existing Kentucky Insurance Code requirements, including written denials that provide medically or scientifically grounded reasons consistent with current practice.