Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans
We found significant variability in medical policy determinations and evidence cited for clinically relevant PGx tests among major US health insurers and LBMs. A collaborative effort between payers and the PGx community to standardize evidence evaluation may lead to more consistent coverage and improve patient access to PGx tests meeting evidence requirements.
Authors
- Sara Rogers (ORCID: https://orcid.org/0000-0002-9851-4151)
- Jai N. Patel (ORCID: https://orcid.org/0000-0001-9845-3697)
- Emily S. Reese (ORCID: https://orcid.org/0000-0001-9729-1665)
- Benjamin Brown (ORCID: https://orcid.org/0000-0002-5068-3255)
- Olivia M Dong (ORCID: https://orcid.org/0000-0003-2241-5402)
- Lena Chaihorsky
- Christine Y. Lu (ORCID: https://orcid.org/0000-0002-7550-6837)
- Wrenda Teeple
- Chad Moretz (ORCID: https://orcid.org/0000-0003-2255-4330)
Institutions
- Levine Cancer Institute (US)
Publication Details
- Journal
- The American Journal of Managed Care
- Published
- 2025-02-07
- DOI
- https://doi.org/10.37765/ajmc.2025.89683
- Citations
- 13
- Primary Topic
- Health Systems, Economic Evaluations, Quality of Life
- Type
- article
- Field-Weighted Citation Impact
- 40.70