In Part 1, we talked about Medicare’s new Chronic Care Management program and how a pharmacist could serve as a clinical services coordinator to get a CCM program up and running.
For Part 2, we examined some CPT billing codes that could be used to reimburse pharmacist-led MTM services in a physician clinic or home health agency.
Part 3 is all about an exciting new trend in “Personalized Medication” consulting.
Interpretation of Pharmacogenomic Test Results
When pharmacogenomics (PGx) testing first came about, it was mostly aimed at oncology, neurology and specialty practices that use genetic testing to guide treatment. This type of genetic testing has been especially beneficial in LTC or nursing home settings where physicians are dealing with bundled payment reforms.
Now testing can be used by physicians and pharmacists to reduce trial and error prescribing and offer a new clinical service to patients.
Physicians can market pharmacogenomic testing as a service to attract new patients as well as the established ones. A pharmacist could perform the non-invasive cheek swab, interpret the results and make recommendations for altering/initiating the medication regimen.
Pharmacists are highly trained in drug metabolism and drug-gene interactions. The most common example is the poor metabolizer of 2C19 failing the pro-drug clopidogrel due to the inability to metabolize it to its active metabolite. More case study examples can be found in the Pharmacy Times article I authored on the subject.
A physician is then able to bill for another office visit to discuss the patient’s test results, which provides an opportunity for additional billing by the practice.
Pharmacists are legally eligible to receive compensation from the testing laboratory by acting as “representatives”. Medicare is fully reimbursing for the test, so the patient is not liable for any out-of-pocket expenses.
The physician could effectively use the pharmacist’s expertise in pharmacokinetics and pharmacogenomics to improve patient outcomes and their bottom line. It can be a win-win for the practice.
What do you think about PGx testing?
Would you be interested in offering this service in your pharmacy?
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