Table 2. . Current and desired states of standardization of pharmacogenomic test ordering and reimbursement.

Process	Current state	Desired state	Ongoing initiatives	Gaps/opportunities
Gene/drug selections	Genes are selected by laboratory doing the test, often structured around reimbursement and clinicians must navigate these tests after determining the gene to interrogate	Must-test genes drive more consistent panel reimbursement and easier ordering process. Disease-specific guidelines provide recommendations of use of genetic test	CPIC – list of actionable genes and corresponding drugs, uses levels of evidence to support clinical utility (https://cpicpgx.org/genes-drugs/)	List updates needed on ongoing basis Effects of WGS/WES on gene selection/reimbursement
Market awareness: available tests and appropriate use	Clinicians under-aware of the types of pharmacogenomic tests available and the clinical utility of each	Userfriendly and intuitive database to provide available tests by medication class and disease state with clinical recommendations for use	GTR (www.ncbi.nlm.nih.gov/gtr/) provides central location for voluntary submission of genetic test information by providers	GTR relies on voluntary submission and could be more complete Resources should be readily understandable by patients
Current reimbursement and out of pocket costs (OOP)	No consensus, little reimbursement for testing outside of oncology, and lack of unique CPT codes	Sharp increase in the number of unique CPT codes for expanding number of tests, payer engagement in requirements from laboratories	Approximately 10 new CPT Tier 1 codes available for 2018 Active research and interest among field	Further understand payer perspectives on pharmacogenomics, especially evidence requirements and decision making processes Develop structures and tools to reuse pharmacogenomic results over time which increases value of testing

CPT: Current procedural terminology; GTR: Genetic testing registry; WES: Whole exome sequencing; WGS: Whole genome sequencing.