Pharmacogenetic and Pharmacodynamic Testing

Aetna covers targeted pharmacogenetic/pharmacodynamic tests when clinically indicated — e.g., ABCD1 mutation and VLCFA testing for patients being evaluated for elivaldogene autotemcel (Skysona), ALK fusion/rearrangement testing for NSCLC patients considered for crizotinib, alectinib or ceritinib (and ALK testing when considering pembrolizumab), and BCR‑ABL mutation testing for CML patients being considered for nilotinib. Aetna considers broad NGS panels (FoundationOne CDx/Liquid CDx and Guardant360 CDx) not medically necessary for determining candidacy for specific targeted therapies (e.g., alectinib, osimertinib, encorafenib, rucaparib) because they provide no proven advantage over targeted single‑gene or small panel testing.

"ALK gene rearrangement for members who are considering pembrolizumab (Keytruda) for the treatment of NSCLC"

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