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What is Pharmacogenomic (PGx) Testing?
Pharmacogenomic testing is identifying genes that may affect enzymes responsible for hepatic metabolism of certain medications.
Remember back in pharmacology and genetics you may remember learning about the Cytochrome P450 enzymes.
Those enzymes are some of the ones that we look at in a pharmacogenomic test.
What Genes Are Tested?
In addition to the CYP450 enzymes, we also look at HLA-A and HLA-B, which indicate the presence of alleles linked to hypersensitivity to carbamazepine or phenytoin.
We also look at OPRM1 which in our mind geotag specifically shows a decreased sensitivity to analgesic but it could go either way.
We also look at the COMT which indicates whether or not the body is producing enzymes that can clear dopamine norepinephrine from the synapse.
We also look at SLCO1B1 which tells us if the patient is more at risk for statin-induced myopathy.
And finally for thrombosis risk we can look at genes that code for Factors 2, 5, and 10 Leiden.
How Do You Bill for Pharmacogenomic Testing?
As far as CPT codes go, there are no CPT codes that code specifically for pharmacogenomic testing.
The patient can be referred to the pharmacist or to the physician for pharmacogenomic testing based on the medications that they’re on and based on their diagnosis.
Some impactful activities for pharmacists wanting to offer pharmacogenomic testing either in their community pharmacy setting or in a physician’s office setting are:
- In collaboration with the practice, to create a formulary of drugs that would benefit from a pharmacogenomic test
- Use pharmacogenomic testing in practices to offer annual wellness visits (AWVs) or chronic care management (CCM) services. A consultant pharmacist could have an ongoing impact on a patients care and continue to use the test throughout the life of the patient.
- If you’re seeing patients and giving them the results of their pharmacogenomics test in a physician’s office setting under collaborative practice you can bill for the pharmacists interpretation using the incident to billing codes.
How can you put a program like this together?
A consultant pharmacist in an off site setting such as a community pharmacy or independent consulting firm could integrate pharmacogenomic testing and consultation into an MTM visit
Lesson 9 in the E-course at the Pharmapreneur Academy is ALL about Pharmacogenomic and Point of Care Testing Services!
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