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PGx FAQ



What is Pharmacogenomic Testing?
Pharmacogenomic testing is a new tool in medicine. It has demonstrated that different individuals respond differently to prescription medications; these differences are genetically determined. Pharmacogenetic testing is the testing of certain genes to determine how any given individual will respond to specific medications. Drugs are metabolized slowly in individuals carrying genetic polymorphisms that reduce enzyme activity, and these individuals are at an increased risk for adverse drug reactions or therapeutic failure. Alternatively, a genetic polymorphism that increases metabolism could result in ineffective drug treatment.

How well Established is the Science?
The science of pharmacogenetics is both well established and rapidly changing. That specific genes influence how an individual reacts to medications is not in doubt. However, the genetic basis for drug efficacy and side effects is better understood with some medications than with others. For certain medical conditions drug choices and specific dosages can be prescribed, for others therapeutic recommendations are not as well understood. Pharmacogenomics holds enormous promise, will reduce medical costs and increase the effectiveness of many drugs in the future.

What Constitutes Pharmacogenomic Evidence?
Our team follows peer-reviewed and published guidelines developed by pharmacogenetic expert groups. Expert groups perform systematic assessments of the scientific findings related to gene-drug pairs and assign a level of evidence score to every finding. The overall evidence is then analyzed and a consensus decision is made on whether or not a specific action is required for a given medication-gene pair.

What might Pharmacogenomic Testing mean for You?
Until recently, drugs have been developed with the idea that each drug works pretty much the same in everybody. But genomic research has changed that "one size fits all" approach and opened the door to more personalized approaches to using and developing drugs. Depending on your genetic makeup, some drugs may work more or less effectively for you than they do in other people. Likewise, some drugs may produce more or fewer side effects in you than in someone else. Knowledge of an individual’s genetic background before beginning treatment could assist in prescribing the appropriate drug at a safe dosage. This greatly decreases the need for trial and error” dosing and can reduce adverse drug reactions substantially.

How Does my Past Medical History Impact Pharmacogenomic Testing?
Discuss prior adverse and inadequate effects with your physician. What has or has not worked well in the past? Are you sensitive to any medication, or do you need higher than normal doses?

What drugs does Pharmacogenetic Testing apply to?
The effect genetic variations have on specific medications is well documented for some drugs, and not well documented for others. In general, drugs with a very narrow effective dosing range have been researched, while drugs with a wide effective range have not.

Is Pharmacogenomic Testing covered by Insurance?
An insured patient will be billed the deductible or co-pay amount based on their insurance policy. If insurance is not available or applicable, a patient will be billed as a cash patient.

Does the cost of Genetic Testing count towards my Deductible?
Yes, it counts towards a deductible if the test is determined to be medically necessary. You will receive an invoice stating your co-pay and deductible.

Is Genetic testing covered by Medicare?
As long as Medicare is the patient’s primary insurance, and the test is deemed medically necessary, it is currently covered by Medicare with no co-pay or deducible. Commercial insurance as primary or Medicare as secondary insurance may have co-pays and deductibles based on each individual’s insurance policy.

Can an insurer or employer deny me coverage based on the results of genetic testing?
In 2008, Congress passed the Genetic Information Nondiscrimination Act (GINA). GINA prohibits health insurance companies from denying coverage or charging higher premiums to an individual based solely on genetic information. GINA also prohibits employers from using your genetic information when making hiring, firing, job placement or promotion decisions.