Table 3.
Coverage Policies for Pharmacogenetic Tests by Insurer (policies were identified in August 2012 as described in the Methods section).
| Test | Drug Indication | Insurer | Tech Assessments | FDA Approvals | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Aetna | Indep-endence BCBS | Cigna | Humana | United Health | BCBS TEC | EGAPP | FDA-cleared test | Revised Drug Label with PGx Info | ||
| Apo E | Lipid lowering medications | No 1 | - | No 2 | - | - | - | -- | No | Yes |
| BRAF | Cetuximab, pantimumab | - | No 3 | - | - | - | - | -- | Yes | No |
| Caris TargetNOW Molecular Profiling | Inform cancer therapy | No 1 | - | - | No 4 | - | - | -- | No | N/A |
| CYP2C19 | Clopidogrel | Yes 1 | Yes 5 | No 6 | No 4 | - | - | -- | Yes | Yes |
| CYP2C19 | Proton Pump Inhibitors | No 1 | No 7 | - | No 4 | - | -- | Yes | Yes | |
| CYP2C9/ VKORC1 | Warfarin | No 1 | No 8 | No 6 | No 4 | - | - | -- | Yes | Yes |
| CYP2D6 | Tamoxifen | No 1 | No 9 | No 6 | No 4 | - | No 10 | -- | Yes | Yes |
| CYP2D6 | Tetrabenezine | Yes 1 | - | - | Yes 4 | - | - | -- | Yes | Yes |
| CYP2D6 | Donepezil | No 1 | - | - | - | - | - | -- | Yes | No |
| CYP2C9 | Proton pump inhibitors | - | - | - | No 4 | - | - | Insufficient evidence to recommend for or against use 11 | No | Yes |
| CYP450 (not specified/multiple) | SSRIs | No 1 | - | No 6 | No 4 | - | - | Insufficient evidence to recommend for or against use 11 | N/A | N/A |
| Dihydropyramidine Dehydrogenase (DPYD) | 5-Fluorouracil | No 1 | - | - | No 4 | - | No 12 | -- | No | Yes |
| EGFR | Erlotinib | Yes 1 | No 13 | - | Yes 4 | - | Yes 14 | -- | No | No |
| ERCC1 | Cisplatin, carboplatin, oxaloplatin | - | - | - | No 4 | - | - | -- | No | No |
| HLA-B*1502 | Carbamazepine | Yes (in Asian patients) 1 | - | - | Yes (in Asian patients) 4 | - | - | -- | No | Yes |
| HLA-B*5701 | Abacavir | Yes 1 | - | Yes 6 | Yes 4 | - | - | -- | No | Yes |
| IL28B | Interferon therapy for Hepatitis C | No 1 | - | - | - | - | - | -- | No | Yes (Peg-interferon α2B, Teleprivir, Boceprivir) |
| KIF6 | Statin | No 15 | -- | No | N/A | |||||
| KRAS | Erlotinib | Yes 1 | No 16 | - | No 4 | - | - | -- | Yes | No |
| MGMT Methylation | Temozolomide (Temodar) | - | - | - | No 4 | - | - | -- | No | No |
| MTHFR | Antifolate chemotherapy | No 1 | - | - | - | - | - | Insufficient evidence for or against 11 | Yes | No |
| rs3798220 | Aspirin | No 1 | - | - | - | - | - | -- | No | No |
| TPMT | Mercaptopurine, azathiopurine | Yes 1 | Yes 17 | Yes 6 | Yes 4 | - | - | -- | No | Yes |
| Thymidylate Synthase | 5-Fluorouracil | No 1 | - | - | - | - | No 18 | -- | No | No |
| Urovysion | Follow-up treatment for bladder cancer | Yes 1 | - | - | - | -- | -- | -- | Yes | N/A |
| UTG1A1 | Irinotecan | No 1 | - | No 19 | No 4 | - | - | -- | Yes | Yes |
| Whole Genome/Whole Exome/Genome-wide Association study | Pharmacogenetics (not specified) | - | - | - | No 4 | - | - | -- | No | N/A |
N/A = not applicable as no individual test or drug specified.
1. http://www.aetna.com/cpb/medical/data/700_799/0715.html (accessed on 30 August 2012).
2. http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0137_coveragepositioncriteria_cardiac_disease_risk_laboratory_studies.pdf (accessed on 30 August 2012).
3. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a700549ef4!OpenDocument (accessed on 30 August 2012).
4. http://apps.humana.com/tad/Tad_New/Home.aspx (accessed on 30 August 2012).
5. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a700549355!OpenDocument (accessed on 30 August 2012).
6. http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0500_coveragepositioncriteria_pharmacogenetic_testing.pdf (accessed on 30 August 2012).
7. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a7005498a6!OpenDocument (accessed on 30 August 2012).
8. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a7005495f8!OpenDocument (accessed on 30 August 2012).
9. http://medpolicy.ibx.com/policies/mpi.nsf/88c0c50066c9d059852574d300564913/85256aa800623d7a852579a700549ac4!OpenDocument (accessed on 30 August 2012).
10. http://www.bcbs.com/blueresources/tec/press/cyp2d6-pharmacogenomics-of.html (accessed on 30 August 2012).
11. http://www.egappreviews.org/docs/EGAPPWG-CYP450Rec.pdf (accessed on 30 August 2012).
12. http://www.bcbs.com/blueresources/tec/vols/24/pharmacogenetic-testing-to.html (accessed on 30 August 2012).
13. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a70054a86d!OpenDocument (accessed on 30 August 2012).
14. http://www.bcbs.com/blueresources/tec/vols/25/epidermal-growth-factor.html (accessed on 30 August 2012).
15. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a70054a2d2!OpenDocument (accessed on 30 August 2012).
16. http://medpolicy.ibx.com/policies/mpi.nsf/a94c009639ca1eb3852573f4006e01c3/85256aa800623d7a852579a70054a4c5!OpenDocument (accessed on 30 August 2012).
17. http://medpolicy.ibx.com/policies/mpi.nsf/6eeddf656d983ec98525695e0068df68/85256aa800623d7a8525796b007119ee!OpenDocument&Highlight=0,tpmt (accessed on 30 August 2012).
18. http://www.bcbs.com/blueresources/tec/press/pharmacogenetic-testing-to.html (accessed on 30 August 2012).
19. http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/mm_0381_coveragepositioncriteria_AmpliChip.pdf (accessed on 30 August 2012).