Pharmacogenetic testing coverage by Canadian insurance providers

In Canada, access to pharmacogenetic (PGx) testing remains limited, particularly outside of research institutions, and commercial testing is often cost-prohibitive. To address access challenges, several Canadian insurance providers have begun offering PGx test coverage; however, the extent and nature of this coverage remain unclear. This study systematically reviewed publicly available PGx coverage policies from Canadian insurance companies to evaluate eligibility requirements, affiliated laboratories, and clinical actionability of test panels. Ten Canadian insurers were identified with publicly accessible PGx testing policies. Six offered partial reimbursement or discounted pricing to all members, while four restricted full coverage to individuals meeting specific criteria, such as being on disability leave or having a physician's diagnosis. Eligibility requirements varied considerably, with some insurers requiring multiple conditions to be met. Four commercial laboratories were affiliated with insurers, but these labs differed substantially in the number of actionable genes and drugs tested. Our findings highlight substantial heterogeneity in insurer eligibility criteria and affiliate lab test comprehensiveness that may create inequities in access and quality of care. Furthermore, variability in insurance coverage may influence clinicians' willingness to recommend testing and patients' ability to access personalized therapy. These findings underscore the need for standardized PGx testing coverage policies and harmonized testing panels. Collaboration among insurers, researchers, and clinicians is essential to generating Canadian-specific evidence to guide equitable and clinically effective PGx implementation.