Pharmacogenomic testing isn’t new, but reimbursements have increased the number of patients being tested.
Who pays for the cost of a pharmacogenetic test?
Pharmacogenomic testing has been around for decades, but up until a few years ago, most people couldn’t afford it. Now CMS (The Centers for Medicare and Medicaid Services) reimburses 100% for Medicare B patients and in select states, 100% for Medicaid patients. Private insurers cover testing based upon medical necessity. There is no cost to physicians, LTC facilities, pharmacies, consultants, or clinics.
Who should receive pharmacogenetic testing?
Pharmacogenetic testing should only be performed based upon medical necessity. Medical necessity is determined by the physician.
The following situations may qualify as medical necessity:
- Patients taking a large number of medications with the potential for serious adverse effects.
- Patients taking medications with a high risk of drug interactions.
- When patients do not respond to drug treatment and options are limited.
- Patients with an unexpected pattern of side effects to medications.
If you are interested in being tested, or you are a healthcare professional and would like to incorporate this program into your day-to-day patient care, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
www.pgsmed.com