The landscape of pharmacogenetic testing in a US managed care population

Abstract

Purpose: Little is known about how many insured patients receive pharmacogenetic testing. We describe trends of single-gene pharmacogenetic testing in a US managed care population, and demographic and clinical characteristics of patients who received a test.

Methods: We leveraged a random sample of nearly 11 million patients from a data set of paid medical and pharmacy claims to identify patients with at least one claim indicating receipt of at least one of these single-gene pharmacogenetic tests: CYP2C19, CYP2D6, CYP2C9, VKORC1, UGT1A1, and HLA class 1 typing.

Results: From 1 January 2013 to 30 September 2017, 5712 patients received at least one pharmacogenetic test (55% female; mean age = 43 years). The median number of tests per patient was 3 (mean = 2.7, max = 12); 54% were processed through Managed Medicare/Medicaid, while 45% were processed through commercial insurance. The total number of pharmacogenetic tests received more than doubled from 2013 (n = 1955) to 2015 (n = 4192), then decreased slightly in 2016 (n = 3946). The most common test was CYP2C19 (n = 4719), and "long-term (current) use of other medications" was the most common diagnosis.

Conclusion: Pharmacogenetic testing through patients' insurance was low, but more than doubled from 2013 to 2016. This study highlights the need to better understand utilization patterns and insurance coverage for pharmacogenetic tests.

Keywords: insurance; managed care; pharmacogenetic; pharmacogenomic; testing.

Fig. 1. Annual counts of each type of single-gene pharmacogenetic test from 2013 to 2017.

Note: 2017 only includes data through 30 September 2017. (a) Annual counts from 2013 to 2017 for all tests (i.e., commercial insurance, managed Medicare/ Medicaid, and other/unknown insurance). (b) Annual counts from 2013 to 2017 for all tests covered by commercial insurance. (c) Annual counts from 2013 to 2017 for all tests covered by managed Medicare/Medicaid.

Fig. 2. Mean coverage amount (i.e., allowed cost) and billed amount for each single-gene pharmacogenetic test of interest from 2013 to 2017, for all tests (i.e., commercial insurance, managed Medicare/Medicaid, and other/unknown insurance).

Note: 2017 only includes data through 30 September 2017. (a) Mean allowed cost from 2013 to 2017. Allowed cost is defined as the contracted or accepted reimbursable amount for covered medical services or supplies that the health plan agrees to pay to service providers. (b) Mean billed amount from 2013 to 2017. Billed amount is defined as the amount billed for services provided by the servicing provider or facility.