Laboratories use the same laboratory equipment they invested in for COVID testing to perform PGx testing. With COVID testing reimbursement dropping, many laboratorians are considering implementing PGx testing. PGx test panel design and test utilization that align with payers’ medical necessity definitions are key to pharmacogenomics laboratories’ financial viability and sustainability. Payers currently recognize some clinical pharmacogenomic (PGx) testing has sufficient clinical utility evidence to justify their coverage and reimbursement for their patient populations and as such have existing coverage and reimbursement and billing and coding guidelines. For the purposes of this webinar, Dr. Winslow will focus on laboratories’ optimizing PGx test panel design and utilization based on payers’ existing coverage and reimbursement guidelines for pharmacogenetic associations that are related to drug metabolizing enzyme gene variants, drug transporter gene variants, and gene variants that predispose a patient to certain adverse events and drug efficacy.

Learning Objectives:

1. Review educated financial decisions when considering implementing clinical PGx testing in the laboratory.

2. Differentiate between implementing a clinical PGx test for which CPT codes and payers’ policies exist and implementing one for which CPT codes and payer policies do not yet exist in terms of time from test implementation to reimbursement.

3. Describe how to optimize PGx test panel design and utilization using payers’ existing coverage and reimbursement guidelines to positively impact the PGx laboratory’s profits and losses.