Yes if indicated below. (4.0 TMPT does not require prior authorization)
|
|
- Roger Park
- 5 years ago
- Views:
Transcription
1 Genetic Testing for Pharmacogenetics MP9479 Covered Service: Prior Authorization Required: Additional Information: Medicare Policy: BadgerCare Plus Policy: Yes when meets criteria below Yes if indicated below. (4.0 TMPT does not require prior authorization) None Prior authorization is dependent on the member s Medicare coverage. Prior authorization is not required for Medicare Cost (Dean Care Gold) and Medicare Supplement (Select) when this service is provided by participating providers. Prior authorization is required if a member has Medicare primary and Dean Health Plan secondary coverage. This policy is not applicable to our Medicare Replacement product (Dean Advantage). Dean Health Plan covers when BadgerCare Plus also covers the benefit. Dean Health Plan Medical Policy: 1.0 Pharmacogenetic testing requires prior authorization through the Health Services Division and is medically necessary when EITHER of the following criteria have been met: 1.1 The individual is a candidate for a targeted drug therapy associated with a specific genotype, AND The results of the pharmacogenetics test will directly impact clinical decision-making and clinical outcome for the individual, AND Published, peer-reviewed studies have proven that identifying the specific genetic variant improves clinical outcomes. 1.2 Identification of the genetic variant is required prior to initiating therapy with the target drug as noted by the U.S. Food and Drug Administration (FDA) approved prescribing label. 2.0 Multi-gene pharmacogenetics genotyping assays that do not meet the above criteria are considered experimental and investigational and therefore are not medically necessary. Genetic Testing for Pharmacogenetics 1 of 6
2 3.0 The following pharmacogenomic tests require prior authorization and are considered medically necessary when the criteria in either 1.1 or 1.2 have been met: 3.1 One genotyping for CYP2C19 polymorphisms for persons who have been prescribed PLAVIX (clopidogrel). Repeat CYP2C19 genotyping has no proven value; 3.2 One genotyping for CYP2D6 polymorphisms for persons who have been prescribed doses of XENAZINE (tetrabenazine) greater than 50 mg per day. Repeat CYP2D6 genotyping has unproven value. 3.3 One genotyping for CYP2D6 polymorphisms for persons with Gaucher disease type 1 who are being considered for treatment with CERDELGA (eliglustat). Repeat CYP2D6 genotyping has no proven value. 3.4 Genotyping for HLA-B 1502 for persons with Asian ancestry before starting treatment with TEGRETOL (carbamazepine), DILANTIN (phenytoin), or CEREBYX (fosphenytoin). 3.5 HLA-B for persons who are infected with HIV-1 before starting treatment with ZIAGEN (abacavir). 3.6 BRAF V600E mutation (the cobas 4800 BRAF mutation test) for person who are considering ZELBORAF (vemurafenib) for the treatment of unresectable or metastatic melanoma. 3.7 CFTR gene testing for persons with cystic fibrosis who are being considered for treatment with KALYDECO (ivacaftor). 3.8 CFTR gene testing for persons with cystic fibrosis who are being considered for treatment with ORKAMBI (lumacaftor/ivacaftor). 3.9 Anaplastic lymphoma kinase (ALK) fusion gene (e.g. the Vysis ALK Break Apart FISH Probe Kit) for persons who are considering XALKORI (crizotinib) or ZYKADIA (ceritinib) for the treatment of non-small cell lung cancer (NSCLC) MGMT (O(6)-methylguanine-DNA methyltransferase) gene mutation assay for predicting response to TEMODAR (temozolomide) in persons with glioblastoma The THxID BRAF test for detecting mutation of the BRAF gene (V600E or V600K) in persons with unresectable or metastatic melanoma who are being considered for treatment with TAFINLAR (dabrafenib), or MEKINIST (trametinib) Testing for the presence of virus with the NS3 Q80K polymorphism for persons with hepatitis C virus (HCV) genotype 1a infection being considered for treatment with OLYSIO (simeprevir). Genetic Testing for Pharmacogenetics 2 of 6
3 3.13 Genotyping for HLA-B 58:01 prior to starting allopurinol therapy Warfarin Pharmacogenetics - CYP2C9, CYP4F2, and VKORC1 Genes testing may be indicated when ALL of the following are present Age 18 years and older; AND Venous thromboembolism prophylaxis with warfarin planned for elective hip or knee arthroplasty; AND No known bleeding disorder or thrombophilia. 4.0 TPMT gene mutation or TPMT phenotypic assays are considered medically necessary prior to initiation of 6-mercaptopurine or azathioprine therapy and does not require prior authorization. 4.1 Only 1 genotypic or phenotypic assay of TPMT activity is necessary per member per lifetime. 4.2 TPMT gene mutation assays and TPMT phenotypic assays are considered experimental and investigational for all other indications because their effectiveness for indications other than the one listed above has not been established. 5.0 The following tests are considered experimental and investigational and therefore are not medically necessary: 5.1 CYP2D6 genotyping for predicting response to beta blockers 5.2 CYP2D6 genotyping for individual s with Alzheimer s disease 5.3 UGT1A1 molecular assay 5.4 Apolipoprotein E (ApoE) 5.5 MTHFR genotyping 5.6 Measurement of thromboxane metabolites in urine (e.g. AspirinWorks) 5.7 rs allele 5.8 Area under the curve (AUC)-targeted 5-fluorouracil dosing (e.g. Myriad Genetics OnDose) 5.9 IL28B gentotyping 5.10 Psychotropic Medication Pharmacogenetics Gene Panel (e.g. GeneSight Rx) 5.11 Platelet reactivity/function testing (VerifyNow P2Y12 Assay, Ultegra System Rapid Platelet Function Assay-ASA) 5.12 Genecept Assay (Genomind) 5.13 Methotrexate polyglutamates (Avise PG test) Genetic Testing for Pharmacogenetics 3 of 6
4 5.14 Beta adrenergic receptor genotyping 5.15 Millenium PGT (Millennium Laboratories) 5.16 PersonaGene Genetic Panels (AlBioTech) 5.17 A1555G genotyping 5.18 Proove Narcotic Risk Panel and the Proove Drug Metabolism Panel 5.19 DPYD genes 5.20 TYMS genes 5.21 ADRA2A, COMT, CYP2B6 genes 5.22 GRIK4 gene CITALOPRAM pharmacogenetics 5.23 OPRM1 gene NALTREXONE pharmacogenetics CPT/HCPCS Codes Related to MP9479 * The list of codes (and their descriptors, if any) is provided for informational purposes only and may not be all inclusive or current. Listing of a code in this medical policy does not imply that the service described by the code is a covered or non-covered service. Benefit coverage for any service is determined by the member s policy of health coverage with Dean Health Plan. Inclusion of a code above does not imply any right to reimbursement or guarantee claim payment. Other medical policies may also apply BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s) CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines) CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and capecitabine drug metabolism), gene analysis, common variant(s) F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant Genetic Testing for Pharmacogenetics 4 of 6
5 81241 F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme), methylation analysis MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants TPMT (thiopurine S-methyltransferase) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3) UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, irinotecan metabolism), gene analysis, common variants VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and -DQB HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) HLA Class I typing, low resolution (eg, antigen equivalents); complete HLA Class I typing, low resolution (eg, antigen equivalents); one locus, each HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equivalent (eg, B*27), each HLA Class II typing, low resolution (eg, antigen equivalents); HLA- DRB1/3/4/5 and -DQB HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or - DPA1), each HLA Class II typing, low resolution (eg, antigen equivalents); one antigen equivalent, each HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA-A, -B, and -C) HLA Class I typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, B*57:01P), each Molecular Pathology Procedure Level Molecular Pathology Procedure Level Unlisted molecular pathology procedure Thromboxane metabolite(s), including thromboxane if performed, urine Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics Genetic Testing for Pharmacogenetics 5 of 6
6 87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus Molecular cytogenetics; DNA probe, each (eg, FISH) Molecular cytogenetics; interphase in situ hybridization, analyze cells Molecular cytogenetics; interphase in situ hybridization, analyze cells Morphometric analysis, in situ hybridization (quantitative or semiquantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure Morphometric analysis, in situ hybridization (quantitative or semiquantitative), manual, per specimen; each multiplex probe stain procedure S3852 DNA analysis for APOE epsilon 4 allele for susceptibility to Alzheimer's disease 0030U Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs ) Originated: Revised: Reviewed: Committee/Source Date(s) April 3, 2017 Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division June 21, 2017 May 16, 2018 August 15, 2018 June 21, 2017 May 16, 2018 August 15, 2018 Published/Effective: 09/01/2018 Genetic Testing for Pharmacogenetics 6 of 6
Genetic Testing for Pharmacogenetics
Genetic Testing for Pharmacogenetics MP9479 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes-as shown below (1.0 and 3.0) Additional Information: None Prevea360 Health Plan
More informationPharmacogenetic and Pharmacodynamic Testing PHARMACOGENETIC AND PHARMACODYNAMIC TESTING HS-318. Policy Number: HS-318
Easy Choice Health Plan, Inc. Exactus Pharmacy Solutions, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Incorporated WellCare Health Insurance of Arizona, Inc., operating in Hawai i as Ohana
More informationPantoprazole icd 10 code
Pantoprazole icd 10 code in persons with recurrent or metastatic non-small cell lung cancer who are being considered for treatment with dabrafenib (Tafinlar), pembrolizumab (Keytruda), or vemurafenib (Zelboraf);
More informationCPT Codes for Pharmacogenomic Tests
CPT s for Pharmacogenomic Tests The table below lists CPT codes and lab fee information for pharmacogenomic tests as established by the Centers for Medicare and Medicaid Services. It was compiled by the
More informationWhat s New Medical Policy Updates October 2018
What s New Medical Policy Updates October 2018 Listed below are the recent changes made to policies within the Geisinger Health Plan Medical Policy Portfolio during the month of September that will become
More informationClinical Policy: Pharmacogenetic Testing Reference Number: CP.MP.HN348
Clinical Policy: Pharmacogenetic Testing Reference Number: CP.MP.HN348 Effective Date: 6/07 Last Review Date: 5/17 Coding Implications Revision Log See Important Reminder at the end of this policy for
More informationGenetic Screening for ADR
Genetic Screening for ADR Mahidol University Faculty of Medicine Siriraj Hospital Manop Pithukpakorn, MD Division of Medical Genetics Department of Medicine concentration Drug level over time toxic optimum
More informationPolicy. (https://www.aetna.com/) Number: *Pleasesee amendment forpennsylvaniamedicaidatthe endofthis CPB.
1 of 161 (https://www.aetna.com/) Number: 0715 Policy *Pleasesee amendment forpennsylvaniamedicaidatthe endofthis CPB. I. Cytochrome P450 polymorphisms A. Aetna considers one genotyping for CYP2C19 polymorphisms
More informationJOHNS HOPKINS HEALTHCARE
Page 1 of 13 ACTION: New Effective Date: 12/04/2015 Revising : Review Dates: 09/02/16, 03/03/17 Superseding Archiving Retiring Johns Hopkins HealthCare LLC (JHHC) provides a full spectrum of health care
More informationVariability Due to Genetic Differences
1 Variability Due to Genetic Differences Nick Holford Dept Pharmacology & Clinical Pharmacology University of Auckland 2 Objectives Understand how between individual variation may contribute to :» drug
More informationNational Medical Policy
National Medical Policy Subject: Pharmacogenetic Testing Policy Number: NMP348 Effective Date*: June 2007 Updated: May 2015 This National Medical Policy is subject to the terms in the IMPORTANT NOTICE
More informationPrior Authorization Required: Additional Information:
Genetic Testing for Somatic Tumor Markers MP9486 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below No A first-degree relative is defined as an individual
More informationGENETIC TESTING FOR TARGETED THERAPY FOR NON-SMALL CELL LUNG CANCER (NSCLC)
CANCER (NSCLC) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs are
More informationGenetics and Genomics: Influence on Individualization of Medication Regimes
Genetics and Genomics: Influence on Individualization of Medication Regimes Joseph S Bertino Jr., Pharm.D., FCCP Schenectady, NY USA Goals and Objectives To discuss pharmacogenetics and pharmacogenomics
More informationGan GG Department of Medicine University Malaya Medical Centre Kuala Lumpur
Gan GG Department of Medicine University Malaya Medical Centre Kuala Lumpur outline Definitions Genetic polymorphisms and drugs therapy a)warfarin b) Mercaptopurine c) Methotrexate d) Clopidogrel e) others
More informationTECHNICAL NOTICE. The CPT coding in this notice is effective January 1, 2013 and replaces the coding currently in use for these assays
TECHNICAL NOTICE The CPT coding in this notice is effective January 1, 2013 and replaces the coding currently in use for these assays December 2012 The notation (MAAA) indicates "Multianalyte Assay with
More informationGuidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Gene(s)/Level of evidence
Drug Gene(s)/Level of evidence Guidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Haloperidol CYP2D6 ( SLC6A5 ( 2D6: DPWG guidelines Reduce dose by 50% in PMs Aripiprazole
More informationTailoring Drug Therapy Based on Genotype. Larisa H. Cavallari, Pharm.D. Associate Professor, Department of Pharmacy Practice
Tailoring Drug Therapy Based on Genotype Larisa H. Cavallari, Pharm.D. Associate Professor, Department of Pharmacy Practice University of Illinois at Chicago 833 S. Wood St., Rm 164 Chicago, IL 60612 Tel:
More informationcustom fused glass tile Important Copy: custom glass tile and fused glass tile Custom Glass Tile
custom fused glass tile Custom Glass Tile Important Copy: custom glass tile and fused glass tile Aetna considers an FTL3 mutation assay (e.g., LeukoStrat CDx FLT Mutation Assay) medically necessary for
More informationPharmacogenomic Testing for Warfarin Response (NCD 90.1)
Policy Number 90.1 Approved By UnitedHealthcare Medicare Reimbursement Policy Committee Current Approval Date 01/08/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare
More informationDeliverable 2.1 List of relevant genetic variants for pre-emptive PGx testing
GA N 668353 H2020 Research and Innovation Deliverable 2.1 List of relevant genetic variants for pre-emptive PGx testing WP N and Title: WP2 - Towards shared European Guidelines for PGx Lead beneficiary:
More informationDiagnostic test Suggested website label Description Hospitals available
Diagnostic test Suggested website label Description Hospitals available Abbott Molecular Inc, PATHVYSION HER-2 DNA Probe Kit (FISH) PathVysion kit A diagnostic tool used to determine whether a particular
More informationCorporate Medical Policy
Corporate Medical Policy Molecular Analysis for Targeted Therapy for Non-Small Cell Lung File Name: Origination: Last CAP Review: Next CAP Review: Last Review: molecular_analysis_for_targeted_therapy_for_non_small_cell_lung_cancer
More informationPrior Authorization. Additional Information:
Genetic Testing for Cowden Syndrome - PTEN Gene MP9488 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below Pre and post-test genetic
More informationCorporate Medical Policy
Corporate Medical Policy BRAF Gene Mutation Testing to Select Melanoma or Glioma Patients File Name: Origination: Last CAP Review: Next CAP Review: Last Review: braf_gene_mutation_testing_to_select_melanoma_or_glioma_patients_for_targeted_
More informationCMS will not implement the new tier codes for Medicare/Medicaid claims for calendar year 2012.
January 1, 2012 Re: 2012 AMA CPT Code Changes Dear Valued Client: The American Medical Association (AMA) has made Current Procedural Terminology (CPT) code changes to the 2012 edition of the CPT coding
More informationDelivering on the Promise of Personalised Healthcare
Delivering on the Promise of Personalised Healthcare Dr John S Mills Diagnostic Team Director, Personalised Healthcare and Biomarkers Function, AstraZeneca, UK EBF 6 th Open Symposium, Barcelona, 20 Nov
More informationMekinist. Mekinist (trametinib) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.38 Subject: Mekinist Page: 1 of 6 Last Review Date: June 22, 2017 Mekinist Description Mekinist (trametinib)
More informationCorporate Medical Policy
Corporate Medical Policy Genetic Testing for Mental Health Conditions File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_mental_health_conditions 1/2014 6/2017 6/2018
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Mekinist) Reference Number: CP.PHAR.240 Effective Date: 07.01.16 Last Review Date: 08.18 Line of Business: Commercial, HIM, Medicaid Revision Log See Important Reminder at the end of
More information3. Describe how variants in the CYP2C19 gene impact Plavix metabolism. 4. Compare molecular genetic technologies for pharmacogenomics testing
UP! UNDERSTANDING PHARMACOGENOMICS (PGX) Robert Pyatt Ph.D., Director Sanford Medical Genetics and Genomics Laboratories and Associate Professor, Dept of Internal Medicine, University of South Dakota April
More informationMolecular Diagnostics Overview JAN A. NOWAK, PHD, MD PATHOLOGY AND LABORATORY MEDICINE MOLECULAR DIAGNOSTICS LABORATORY FEBRUARY 15, 2018
Molecular Diagnostics Overview JAN A. NOWAK, PHD, MD PATHOLOGY AND LABORATORY MEDICINE MOLECULAR DIAGNOSTICS LABORATORY FEBRUARY 15, 2018 Some Key Points Molecular Testing has applications in every section
More informationPrior Authorization. Additional Information:
Genetic Testing for Lynch Syndrome MP9487 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes-as shown below Pre and post test genetic counseling is
More informationGenetic Testing for Inherited Conditions
Genetic Testing for Inherited Conditions Policy Number: 2018-101 Effective Date: January 26, 2018 Review Date: January 26, 2018 Next Review Date: January 26, 2019 Important Information - Please Read Before
More informationClinical Policy: Dabrafenib (Tafinlar) Reference Number: CP.PHAR.239 Effective Date: 07/16 Last Review Date: 07/17 Line of Business: Medicaid
Clinical Policy: (Tafinlar) Reference Number: CP.PHAR.239 Effective Date: 07/16 Last Review Date: 07/17 Line of Business: Medicaid Coding Implications Revision Log See Important Reminder at the end of
More informationTafinlar. Tafinlar (dabrafenib) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.37 Subject: Tafinlar Page: 1 of 8 Last Review Date: September 20, 2018 Tafinlar Description Tafinlar
More informationFONS Nové sekvenační technologie vklinickédiagnostice?
FONS 2010 Nové sekvenační technologie vklinickédiagnostice? Sekvenování amplikonů Sequence capture Celogenomové sekvenování FONS 2010 Sekvenování amplikonů Amplicon sequencing - amplicon sequencing enables
More informationImipramine therapy (CYP2D6)
Imipramine therapy (CYP2D6) Intake Start therapy 1st conc 08:00 2nd conc 3e spiegel 4e spiegel 1 week 1 week 1 week 1 week 1 week 22:00 ~ 50% patients need dose adjustment Imipramine therapy (CYP2D6) Intake
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Tafinlar) Reference Number: CP.PHAR.239 Effective Date: 11.16.16 Last Review Date: 08.18 Line of Business: Commercial, HIM, Medicaid Revision Log See Important Reminder at the end of
More informationBig data vs. the individual liver from a regulatory perspective
Big data vs. the individual liver from a regulatory perspective Robert Schuck, Pharm.D., Ph.D. Genomics and Targeted Therapy Office of Clinical Pharmacology Center for Drug Evaluation and Research Food
More informationGenetic Testing for BRCA1 and BRCA2 Genes
Genetic Testing for BRCA1 and BRCA2 Genes MP9478 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below Pre and post-test genetic counseling
More informationCORE DME PANEL Highlands Parkway, Suite 100 Smyrna, GA 30082
CORE DME PANEL Castle's CORE DME panel predicts the activity levels of key - drug metabolizing enzymes in the cytochrome P450 superfamily: CYP2D6, CYP2C9, CYP2C19, CYP2B6, CYP3A4, and - CYP3A5. Apart from
More informationPharmacogenomics and Pharmacokinetics ^
Pharmacogenomics and Pharmacokinetics ^ avid F. Kisor, B.S., Pharm.. Profeor of Pharmacokinetics epartment of Pharmaceutical and Biomedical Sciences Raabe College of Pharmacy Ohio Northern University Learning
More informationZ Code Listing. Performing Site Test Code Test Description Z Code CPT Codes* IU 75950R 1p 19q FISH ZB1K BCL6 Break apart
Z Code Listing Performing Site Test Code Test Description Z Code CPT Codes* IU 75950R 1p 19q FISH ZB1K4 BCL6 Break apart IU 75989 FISH ZB1K7 c-myc Break apart IU 75948 FISH ZB1KQ IU 75993 Her2 neu FISH
More informationZ Code Listing. Performing Site Test Code Test Description Z Code CPT Codes* IU 75950R 1p 19q FISH ZB1K BCL6 Break apart
Z Code Listing Performing Site Test Code Test Description Z Code CPT Codes* IU 75950R 1p 19q FISH ZB1K4 BCL6 Break apart IU 75989 FISH ZB1K7 c-myc Break apart IU 75948 FISH ZB1KQ IU 75993 Her2 neu FISH
More informationGenetic Testing for Somatic Tumor Markers
Genetic Testing for Somatic Tumor Markers MP9486 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes-as shown below Genetic testing is covered for a
More informationMEDICAL POLICY SUBJECT: GENOTYPING CYTOCHROME P450 2C9 (CYP2C9) AND VITAMIN K EPOXIDE REDUCTASE SUBUNIT CI (VKORC) THAT AFFECT RESPONSE TO WARFARIN
MEDICAL POLICY SUBJECT: GENOTYPING CYTOCHROME P450 2C9, PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product,
More informationUSING GENETICS TO DRIVE TREATMENT: A FOCUS WARFARIN
Volume 23, Issue 10 July 2008 USING GENETICS TO DRIVE TREATMENT: A FOCUS ON WARFARIN Gregory J. Welder, Pharm.D. candidate The use of genetics in health care has become a mechanism for identifying risk.
More informationCorporate Medical Policy
Corporate Medical Policy BRAF Gene Variant Testing to Select Melanoma or Glioma Patients File Name: Origination: Last CAP Review: Next CAP Review: Last Review: braf_gene_variant_testing_to_select_melanoma_or_glioma_patients_for_targeted_
More informationHow to use pharmacogenetics to select patients for pharmaceutical care
How to use pharmacogenetics to select patients for pharmaceutical care Prof. Henk-Jan Guchelaar Dept. of Clinical Pharmacy & Toxicology Leiden University Medical Center University of Leiden PCNE Working
More informationGenomics (HMGP 7620) Pharmacogenomics.
Genomics (HMGP 7620) Pharmacogenomics http://unlockinglifescode.org/explore/genomic-medicine/pharmacogenomics Matthew Taylor MD PhD matthew.taylor@ucdenver.edu Variety is the Spice of Life Current Model:
More informationINDIVIDUALIZED PATIENT THERAPY: IS IT MORE THAN A BUZZWORD?
INDIVIDUALIZED PATIENT THERAPY: IS IT MORE THAN A BUZZWORD? Kristin Wiisanen Weitzel, PharmD, FAPhA Clinical Associate Professor and Associate Chair, Pharmacotherapy and Translational Research, UF College
More informationObjectives. Clinical Problem. What if there were a way. Pharmacogenomics in Current Practice MEDICINE 12/1/2017
Objectives Pharmacogenomics in Current Practice Trinh Pham, PharmD, BCOP Associate Clinical Professor University of Connecticut School of Pharmacy Review the concept of pharmacogenetics and pharmacogenomics
More informationPharmacogenomics in Current Practice. Trinh Pham, PharmD, BCOP Associate Clinical Professor University of Connecticut School of Pharmacy.
Pharmacogenomics in Current Practice Trinh Pham, PharmD, BCOP Associate Clinical Professor University of Connecticut School of Pharmacy Objectives Review the concept of pharmacogenetics and pharmacogenomics
More informationCytochrome p450 Genotyping
Cytochrome p450 Genotyping Policy Number: Original Effective Date: MM.02.004 04/01/2011 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 07/27/2018 Section: Medicine Place(s) of
More informationMEDICAL POLICY EFFECTIVE DATE: 12/20/07 REVISED DATE: 12/18/08, 12/17/09, 12/16/10, 12/15/11, 12/20/12, 12/19/13
MEDICAL POLICY SUBJECT: GENOTYPING CYTOCHROME P450 2C9 PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationCLINICAL MEDICAL POLICY
Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Molecular Tumor Markers for Non-Small Cell Lung Cancer (NSCLC) MP-061-MD-DE Medical Management Provider Notice Date: 10/15/2018;
More informationMEDICAL POLICY EFFECTIVE DATE: 12/20/07 REVISED DATE: 12/18/08, 12/17/09, 12/16/10, 12/15/11, 12/20/12, 12/19/13, 12/18/14
MEDICAL POLICY SUBJECT: GENOTYPING CYTOCHROME P450 2C9 PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationGenetic Testing for Lynch Syndrome
Genetic Testing for Lynch Syndrome MP9487 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes-as shown below Pre and post-test genetic counseling is
More informationObjectives Making CYP450, Drug Interactions, & Pharmacogenetics Easy
Objectives Making, Drug Interactions, & Pharmacogenetics Easy Anthony J. Busti, MD, PharmD, FNLA, FAHA Describe the differences between phase I and phase II metabolic pathways. Identify the most common
More informationClinical Policy: Nivolumab (Opdivo) Reference Number: CP.PHAR.121 Effective Date: Last Review Date: Line of Business: Medicaid
Clinical Policy: (Opdivo) Reference Number: CP.PHAR.121 Effective Date: 07.15 Last Review Date: 01.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationReview of Pharmacogenetic Testing Today
Review of Pharmacogenetic Testing Today Gwen McMillin, PhD ARUP Laboratories University of Utah Salt Lake City, Utah A customer says to the pharmacist: "Why does my medication have 40 side effects?" The
More informationOriginal Policy Date
MP 2.04.76 Genetic Counseling Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Created Local Policy/ 12:2013 Return to Medical Policy Index Disclaimer
More informationPrecision Medicine Under the Big Sky
Precision Medicine Under the Big Sky Erica L. Woodahl, Ph.D. Associate Professor Department of Biomedical and Pharmaceutical Sciences University of Montana Disclosure Statement Presenter has no financial
More informationPharmacogenetics in oncology: Where we stand today?
Review Article DOI: http://dx.doi.org/10.18203/issn.2456-3994.intjmolimmunooncol20164382 Pharmacogenetics in oncology: Where we stand today? Padmaj S. Kulkarni Department of Medical Oncology, Deenanath
More informationTARGETED THERAPY FOR LUNG CANCER. Patient and Caregiver Guide
TARGETED THERAPY FOR LUNG CANCER Patient and Caregiver Guide TARGETED THERAPY FOR LUNG CANCER Patient and Caregiver Guide TABLE OF CONTENTS Why Targeted Therapy?...2 Lung Cancer Basics...2 Changes in
More informationMolecular Oncology, oncology parameters see each test
Molecular Oncology, oncology parameters see each test DPD deficiency Dihydropyrimidine dehydrogenase deficiency (DPD deficiency) is an autosomal recessive metabolic disorder in which there is absent or
More informationGenetic Testing for Diagnosis and Management of Mental Health Conditions
Genetic Testing for Diagnosis and Management of Mental Health Conditions Policy Number: Original Effective Date: MM.02.026 07/01/2015 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration
More information2/28/2010. Pharmacogenomics and the Asian Population. Limited efficacy/response to drugs already on the market
Pharmacogenomics and the Asian Population Majority are medication related Alan H.B. Wu, Ph.D. Professor, Laboratory Medicine, UCSF Section Chief, Clinical Chemistry, February 27, 20 Limited efficacy/response
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_5_fluorouracil_use_in_cancer_patients 1/1/2019 NA 1/1/2020 1/2019 Policy Effective April
More informationPage 61 PHARMACOGENETIC AND TUMOUR DRUGS. Table 1. Genetic polymorphisms known to affect responses to anticancer drugs.
PHARMACOGENETIC AND TUMOUR DRUGS polymorphisms known to affect responses to anticancer drugs are presented in Table 1. Table 1. Genetic polymorphisms known to affect responses to anticancer drugs Elizabeta
More informationACMG/CAP Cytogenetics CY
www.cap.org Cytogenetics Analytes/procedures in bold type are regulated for proficiency testing by the Centers for Medicare & Medicaid Services ACMG/CAP Cytogenetics CY Analyte CY Challenges per Shipment
More informationPrior Authorization Required: Yes as shown below
PROLIA, XGEVA (denosumab) MB9409 Covered Service: Prior Authorization Required: Additional Information Medicare Policy: BadgerCare Plus Policy: Yes when meets criteria below Yes as shown below Must be
More informationThe Genie Is Out of the Bottle. Richard E. Ya Deau, MD FACS, FACHCE (HON)
The Genie Is Out of the Bottle Richard E. Ya Deau, MD FACS, FACHCE (HON) Participatory Research 23andme Your genetic data Richard YaDeau Genes vs. Environment 60-80 % Attributable to Genetics The heritability
More informationMedical Policy. MP Genetic Testing for Mental Health Conditions
Medical Policy MP 2.04.110 BCBSA Ref. Policy: 2.04.110 Last Review: 06/22/2017 Effective Date: 06/22/2017 Section: Medicine End Date: 06/26/2018 Related Policies 2.04.38 Cytochrome p450 Genotyping 2.04.82
More informationPharmacogenetics: LabQuality Days Helsinki, February 8, Do you have your DNA passport? Prof Dr Ron van Schaik
LabQuality Days Helsinki, February 8, 2018 Pharmacogenetics: Do you have your DNA passport? Prof Dr Ron van Schaik International Expert Center Pharmacogenetics Dept Clinical Chemistry - Erasmus MC Rotterdam,
More informationPsychotropic & Unnecessary Medication Reduction: Living Longer Better : Utilizing The Clinical Tool of Metabolic Validation Testing
Psychotropic & Unnecessary Medication Reduction: Living Longer Better : Utilizing The Clinical Tool of Metabolic Validation Testing CMS NEWEST GUIDELINES CMS will push nursing homes to reduce their use
More informationCorporate Medical Policy
Corporate Medical Policy Analysis of MGMT Promoter Methylation in Malignant Gliomas File Name: Origination: Last CAP Review: Next CAP Review: Last Review: analysis_of_mgmt_promoter_methylation_in_malignant_gliomas
More informationPharmacogenetics in: Primary Care. Bradley T. Wajda D.O.
Pharmacogenetics in: Primary Care Bradley T. Wajda D.O. Pharmacogenomics Defined Pharmacogenomics uses information about a person s genetic makeup, or genome, to choose the drugs and drug doses that are
More informationFalk Symposium 156: Genetics in Liver Disease. Pharmacogenetics. Gerd Kullak-Ublick
Falk Symposium 156: Genetics in Liver Disease Pharmacogenetics Gerd Kullak-Ublick Division of Clinical Pharmacology and Toxicology Department of Internal Medicine University Hospital Zurich Freiburg, 8.
More informationPersonalized Prescribing: Using Genetic Testing to Guide Drug and Dose Selection. Lindsay S. Elliott, Pharm.D., CGP
Personalized Prescribing: Using Genetic Testing to Guide Drug and Dose Selection Lindsay S. Elliott, Pharm.D., CGP Disclosure I, Lindsay Elliott, am a pharmacy consultant for Genelex Corporation in conducting
More informationMembership Overview: Total Members: 322 Student Members: 160 Resident Members: 8 Fellow Members: 4
A Closer Look at the Central Nervous System PRN Overview of the PRN The Central Nervous System Practice and Research Network (CNS PRN) provides a forum to encourage networking among pharmacists specializing
More informationMolecular Testing in Lung Cancer
Molecular Testing in Lung Cancer Pimpin Incharoen, M.D. Assistant Professor, Thoracic Pathology Department of Pathology, Ramathibodi Hospital Genetic alterations in lung cancer Source: Khono et al, Trans
More informationClinical Policy: Nivolumab (Opdivo) Reference Number: CP.PHAR.121
Clinical Policy: (Opdivo) Reference Number: CP.PHAR.121 Effective Date: 07/15 Last Review Date: 04/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory
More informationPerceived challenges in genomic-based drug development. Garret A. FitzGerald University of Pennsylvania
Perceived challenges in genomic-based drug development Garret A. FitzGerald University of Pennsylvania Genomics Based Personalization of Medicine A Case in Point in Cancer Aside from emerging resistance.
More informationTafinlar. Tafinlar (dabrafenib) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.04.37 Subject: Tafinlar Page: 1 of 6 Last Review Date: June 19, 2015 Tafinlar Description Tafinlar (dabrafenib)
More informationCorporate Medical Policy
Corporate Medical Policy Laboratory and Genetic Testing for Use of 5-Fluorouracil in Patients File Name: Origination: Last CAP Review: Next CAP Review: Last Review: laboratory_and_genetic_testing_for_use_of_5-fluorouracil_in_patients_with_cancer
More informationBig Data Course Week 7 Test2Learn TM 5/7/16
The site is http://api.test2learn.com Usernames are first letter of first-name + first 3 letters of last name (i.e. John Smith would be jsmi ) Passwords are the same as the usernames. Everyone will need
More informationCirculating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy)
Circulating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy) Policy Number: 2.04.143 Last Review: 1/2019 Origination: 1/2018 Next Review: 1/2020 Policy Blue Cross and Blue Shield
More informationClinical Implementation of Pharmacogenetics Mary V. Relling, Pharm.D.
Clinical Implementation of Pharmacogenetics Mary V. Relling, Pharm.D. Actionable pharmacogenetic gene/drug pairs have been known for a long time Primaquine G6PD Codeine CYP2D6 Thiopurines TPMT 5FU DPYD
More informationMedical Policy Title GENOTYPING URIDINE DIPHOSPHATE GLYCURONOSYLTRANSFERASE (UGT1A1) FOR PATIENTS TREATED WITH IRINOTECAN Policy Number 2.02.
Page: 1 of 5 MEDICAL POLICY MEDICAL POLICY DETAILS Medical Policy Title GENOTYPING URIDINE DIPHOSPHATE GLYCURONOSYLTRANSFERASE (UGT1A1) FOR Policy Number 2.02.34 Category Laboratory Tests Effective Date
More informationXalkori. Xalkori (crizotinib) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.12 Subject: Xalkori Page: 1 of 6 Last Review Date: June 22, 2017 Xalkori Description Xalkori (crizotinib)
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Brigatinib (Alunbrig) Reference Number: CP.PHAR.342 Effective Date: 07.17.17 Last Review Date: 05.18 Line of Business: Commercial; Medicaid Revision Log See Important Reminder at the end
More informationTransform genomic data into real-life results
CLINICAL SUMMARY Transform genomic data into real-life results Biomarker testing and targeted therapies can drive improved outcomes in clinical practice New FDA-Approved Broad Companion Diagnostic for
More informationMEDICAL POLICY. Proprietary Information of YourCare Health Plan
MEDICAL POLICY Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed medical literature generally recognized by the medical community.
More informationKeytruda. Keytruda (pembrolizumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.21.50 Subject: Keytruda Page: 1 of 5 Last Review Date: June 24, 2016 Keytruda Description Keytruda (pembrolizumab)
More informationPharmacogenomics-based individualization of drug therapy
ETH Zurich-JST Workshop on Medical Research, 15 Sep 2008 Pharmacogenomics-based individualization of drug therapy Taisei Mushiroda, Ph.D. Laboratory for Pharmacogenetics Center for Genomic Medicine, RIKEN
More informationThe WARFARIN Study: Genetic Testing and Systems Reengineering to Support Personalized Medicine
The WARFARIN Study: Genetic Testing and Systems Reengineering to Support Personalized Medicine Elizabeth O. Ofili, M.D., M.P.H., F.A.C.C. Professor of Medicine and Chief of Cardiology Associate Dean, Clinical
More information