Pharmacogenetic Panel Testing – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare deems pharmacogenetic multi-gene panels (≥5 genes) — including the PrismRA molecular signature test for predicting anti‑TNF response in RA — unproven and not medically necessary for any indication. The policy specifies no covered indications or documentation/prior‑authorization requirements for these multi-gene panels (CPT codes listed are for reference and do not imply coverage).

"None — The policy states: "The use of pharmacogenetic Multi-Gene Panels (five or more genes) for the evaluation of drug-metabolizer status is unproven and not medically necessary for any indication..."

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