To amend title XVIII of the Social Security Act to require coverage of lung cancer biomarker testing under the Medicare program.
Sponsors
Legislative Progress
IntroducedMr. Gottheimer (for himself and Mrs. Kiggans of Virginia) introduced …
Summary
What This Bill Does
This bill requires Medicare to cover biomarker testing for lung cancer patients starting January 1, 2027. Biomarker tests analyze a patient's tissue, blood, or bodily fluids to identify specific genes, proteins, or molecules that help doctors determine the most effective treatment approach. Medicare will pay 100% of the reasonable charges with no cost-sharing required from patients.
Who Benefits and How
Lung cancer patients on Medicare benefit by gaining guaranteed coverage for biomarker testing at no out-of-pocket cost, enabling personalized treatment decisions. Diagnostic laboratories and biomarker testing companies benefit from guaranteed Medicare reimbursement at full reasonable charges. Oncologists benefit from having clearer coverage for tests that guide treatment decisions.
Who Bears the Burden and How
Medicare (federal government) bears the cost of covering these tests at 100%. The Congressional Budget Office would need to score the fiscal impact. There are no new regulatory burdens on healthcare providers beyond standard Medicare billing.
Key Provisions
- Defines "lung cancer biomarker testing" as tests identifying genes, proteins, or molecules from tissue, blood, or bodily fluids
- Sets Medicare payment at 100% of reasonable charges (no patient cost-sharing)
- Effective date of January 1, 2027
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Requires Medicare to cover lung cancer biomarker testing at 100% with no patient cost-sharing, effective January 1, 2027.
Policy Domains
Legislative Strategy
"Expand Medicare coverage to support precision medicine and personalized cancer treatment"
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
Key Definitions
Terms defined in this bill
A test furnished on or after January 1, 2027, to an individual diagnosed with lung cancer for the identification of 1 or more specific biomarkers (such as genes, proteins, or other molecules) based on the analysis of such individual's tissue, blood, or bodily fluids
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology