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Health insurance is often a roadblock for some cancer testing. A new Oklahoma bill would change that


Biomarker testing is a tool that doctors use to get a clearer picture of a medical problem — often cancer.

After Carla Prothro quit smoking, she went in for a check-up.

"[The] doctor said, 'Well, let’s go get one of those lung cancer screenings.'" she said. "And I was like, 'OK, yeah, sure.'"

She hadn’t had any concerning symptoms — no cough, no chest pain. It was just to be safe.

"The scan came back and showed about a tennis ball-sized tumor in one lung — left side," she said. "Maybe a dime-to-a-nickel-sized tumor in the right one — lower lung. So just based off of X-rays, they automatically were like, 'It’s stage four, we’re sure that the big guy in the left lung has caused the little guy in the right one.'"

If this had happened a decade or two earlier, that might have been the end of diagnostics before designing a treatment plan.

“But what happened was they did biomarker testing,” Prothro said. “In a nutshell, it showed them that I had two primary cancers. It had not spread.”

Biomarker testing is a tool that doctors use to get a clearer picture of a medical problem — often cancer. Biomarkers are proteins, genes, or some other substance in a sample that gives doctors clues about the patients’ needs. In Prothro’s case, her samples showed two different forms of cancer that needed different treatments.

The practice has been evolving since the 1970s, but that evolution has sped up over the past few years. Providers and patients say it can be difficult to get insurance companies to cover it.

Oklahoma lawmakers are working to change that. Health and Human Services Chairman Paul Rosino authored Senate Bill 513.

"We're now going to require insurance," he said in the committee hearing. "This expands besides just cancer. It's targeted for so many other possibilities for other treatments that are not covered."

He mentioned specific other conditions where biomarker testing can be helpful, such as multiple sclerosis and Alzheimer's Disease.

Doctors can use biomarkers to learn more about patients’ specific conditions with a lot of diseases, but cancer is a good example because treating it is so hard.

First, cancer isn’t really one disease. It’s a group of more than 100 diseases. DNA is supposed to tell the cells in our bodies when to stop growing and replicating. For example, "We've made enough skin cells." But when someone has cancer, something has gone wrong, and that shut off doesn’t work anymore. Because cancer affects DNA, everyone’s case is unique.

Dr. Robert Mannel, the director of the Stephenson Cancer Center at OU Health, says biomarker testing is often used in cases like Prothro’s, where the information helps make a more targeted treatment plan. But there are a spate of other ways oncologists can use this testing.

“We frequently use biomarkers to determine if somebody is responding to their therapy,” Mannel said. “And so there may be a biomarker that’s a blood test that — as I give therapy, whether it’s radiation or surgery or chemotherapy — that marker falls? That tells me I’m doing the right thing."

For patients, there can be a major roadblock: health insurance

“Now, these tests are several thousand dollars,” he said. “So for an insurance company, there was always a tendency to want to say, No, I don’t want to do that.”

But the need for this testing — especially for cancer patients — isn’t rare.

“Nobody wants to have cancer,” he said. “It’s going to impact one out of every two Oklahoma men, and one out of every three Oklahoma women. It is a big problem. And even these days, with advanced technology and therapies that we have, one out of every three people that get a cancer diagnosis is going to die of their disease.”

More than a dozen states — including several of Oklahoma’s neighbors — are considering similar bills.

"We don't want to risk falling behind our region, frankly, in providing these forms of treatment and covering these forms of treatment for Oklahomans," said Matt Glanville, the Oklahoma government relations director for the Cancer Action Network, which is under the American Cancer Society.

Prothro says she's hoping Oklahoma lawmakers will pass the bill to ensure coverage for people in situations like hers.

"It's amazing I'm still here," she said. "I think I’m going to be here a long time… because of the biomarker testing and because of the treatment that I received."

The bill passed out of the Senate with near-unanimous support this week, and is now headed to the House.


Copyright 2023 KOSU. To see more, visit KOSU.

Catherine Sweeney