Concert Genetic Testing: Pharmacogenetics (Version B)

Pharmacogenetic testing—single‑gene assays and specified multi‑gene panels—to guide drug selection, dosing, or evaluation of adverse drug reactions prior to or during therapy (including molecular testing for solid tumors and hematologic malignancies). Covered populations include adults with psychiatric disorders (e.g., GeneSight-type panels), oncologic, neurologic, cardiovascular/thrombotic, gastrointestinal conditions and specific indications such as HLA‑B*57:01 for HIV, HLA‑B*15:02 for seizure disorders, DPYD for cancer patients, TPMT/NUDT15 for thiopurine therapy, and other ICD‑10–listed diagnoses tied to CYP2D6, CYP3A5, UGT1A1, VKORC1, CYP4F2, etc. Coverage is limited to the tests, panels and ICD‑10 indications listed (adults ≥18), often requires prior medication failure, and many unlisted tests/panels or uses are considered investigational or not covered; inclusion in the document is not a guarantee of coverage.

"Pharmacogenetic testing prior to drug initiation to identify germline variants that may alter drug response or increase risk of drug toxicity."