TRANSPERS student intern, Annie Chang (UCSF Doctor of Pharmacy Candidate, 2019), completed her project on Payer Coverage Policies of CYP450 single gene and panel tests. Below is a summary and link to the full report.
Payer Coverage Policies of CYP450 single gene and panel tests: Clinical and Economic Evidence
Objective: The purpose of this study is to analyze payer coverage of panel-based pharmacogenomics (PGx) genetic testing across the top five commercial payers to determine coverage variations and evaluate the evidence differences that resulted in payer coverage differences for the clopidogrel CYP2C19 test.
Methods: We utilized the TRANSPERS Payer Coverage Policy Registry© containing PGx testing policies from 2015 and updated it with 2016 PGx testing policies. In addition, we also searched for new 2016 PGx policies using previously used inclusion and exclusion criteria. We compared the 2015 and updated 2016 PGx policies noting language and coverage decisions and then analyzed the evidence used to make coverage decisions.
Results: Our findings identified six policies with 35 PGx tests. Updates to four out of the six policies and three new PGx policies have been identified, covering seven policies total. When comparing the 2015 and updated 2016 policies, we found 2 out of 3 payers covered single gene CYP2C19 testing but none covered CYP450 panels. We compared the evidence that the two payers used to make the coverage decision, and found 22 references but only 3 overlapped in each coverage policy.
Conclusion: Coverage and payer evidence cited are not consistent and coverage decisions are not always transparent for single gene CYP2C19 PGx testing for clopidogrel. A more standardized approach between payers and healthcare professionals is necessary to provide more transparent and robust evidence on both single gene PGx testing and CYP450 panel and link payer coverage decisions to available information in the literature.