Creates new GS 58-3-216 (Coverage of biomarker testing), establishing applicable definitions for the statute including “biomarker” and “biomarker testing.” Mandates that a health benefit plan must provide coverage for biomarker testing for diagnosis, treatment, management, and ongoing monitoring of an insured's disease or condition when the biomarker testing is supported by medical and scientific evidence, and provides a list of acceptable support, including FDA label indications and indicated tests, coverage determinations by the Centers for Medicare and Medicaid Services, and nationally recognized clinical practice guidelines and consensus statements. Directs that the coverage under this statute should be provided in a manner that minimizes disruption of patient care such as multiple biopsies or biospecimens.

Amends GS 58-3-215 to include a definition of “biomarker” in subsection (a), and to prohibit an insurer from increasing premiums or contribution rates or refusing to issue or deliver health benefit plans based on biomarker information in subsection (c).

Repeals GS 58-3-215 subparagraph (a)(2), defining "health benefit plan," and (a)(3), defining "insurer."

Effective and applicable to insurance contracts issued, renewed, or amended on or after October 1, 2025.

Amends GS 58-50-61 (Utilization review) to include a definition of “urgent healthcare service” in subparagraph (a)(16a). Amends subsection (f) to create a new timeline for utilization reviews of non-urgent healthcare services and urgent healthcare services, with a 24-hour timeline for urgent healthcare services. Creates new subsections (f1) and (f2) from existing language related to utilization review determination notifications and concurrent review liability, respectively. Reorganizes subsection (m) and provides new language specifying that insurers must provide disclosure of utilization review documents in detail and in easily understandable language, as well as requiring that an insurer make current utilization review requirements and restrictions readily accessible on its website.

Effective and applicable to insurance contracts issued, renewed, or amended on or after October 1, 2025.

Amends GS 135-48.51 to make the new GS 58-3-216 (Coverage of biomarker testing) applicable to the State Health Plan. Applicable beginning with the start of the next plan year after the effective date of the act. Effective October 1, 2025.

Requires the State Treasurer and Executive Administrator of the State Health Plan to review all practices and all contracts with and practices of third parties conducting any utilization review on behalf of the State Health Plan to ensure they comply with the changes of this act. Applicable and effective beginning October 1, 2025.

Appropriates $1,000,000 in recurring funds for each year of the 2025-2027 biennium from the General Fund to the Department of State Treasurer for the State Health Plan to implement the coverage required by this act, effective July 1, 2025.

Requires the Department of Health and Human Services, Division of Health Benefits (DHB), to ensure coverage for biomarker testing under laboratory services clinical coverage policies to the same extent required of a health benefit plan under GS 58-3-216.

Defines “urgent prior authorization request” as any request that could seriously jeopardize the beneficiary’s life if not completed in 72 hours, and requires DHB to ensure these urgent requests are approved or denied within 24 hours after DHB receives all information necessary to complete a review. Requires DHB to complete all non-urgent prior authorization requests within 72 hours after DHB receives all information necessary to complete a review.