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. 2019 Aug 2;10:830. doi: 10.3389/fphar.2019.00830

Table 2.

Pharmacogenomic tests covered by Medicare.

Drug Allele FDA CPIC ICUR Willingness-to-pay threshold Type Reference++
Abacavir HLA-B*5701 Required A $36,700/QALY $50,000–$100,000/QALY CE (60)
DT (64)
Azathioprine TPMT Recommended A $49,156/QALY $50,000/QALY CE (BlueCross Blueshield of Western New York, 2018)
Carbamazepine HLA-B*1502 1 Required A $85,697/QALY $50,000/QALY Not CE (Stolk et al., 2004)
$29,750/QALY $50,000/QALY CE (De Lew, 2000)
Cetuximab KRAS Required Cost saving, same effectiveness (44)
Clopidogrel CYP2C19 2 Actionable A Dominant (Jonsson, 2009, 47)
$4,200/QALY $100,000/QALY CE (Meckley and Neumann, 2010)
Crizotinib ALK Required $136,000/QALY $200,000/QALY CE (Blue Regence, 2019)
Erlotinib EGFR Required
Erlotinib EGFR Required $110,658/QALY $100,000/QALY Not CE (86)
$162,018/QALY $150,000/QALY Not CE (63)
Panitumumab KRAS Required Cost saving, same effectiveness (44)
Phenytoin HLA-B*1502 1 Actionable A $85,697/QALY $50,000/QALY Not CE (Stolk et al., 2004)
$29,750/QALY $50,000/QALY CE (De Lew, 2000)
Trastuzumab ERBB2 (HER-2) Required
Vemurafenib BRAF Required

1HLA-B*1502 is regarded medically necessary and thus reimbursed only for patients of Asian ancestry. 2CYP2C19 testing is regarded as medically necessary only for patients with ACS undergoing PCI who are initiating or reinitiating Clopidogrel therapy. CE, Cost-effective; DT, Dominant. ++Identification number of the article ( Supplementary Table 1 ).