PGx

DID YOU KNOW...

A PGX TEST CAN BE PART OF THE SOLUTION!

PHARMACOGENOMICS TESTING

What is Pharmacogenomics (PGx)?

Pharmacogenomics (sometimes called pharmacogenetics) is a field of research that studies how a person’s genes affect how he or she responds to medications. Its long-term goal is to help doctors select the drugs and doses best suited for each person. It is part of the field of precision, personalized medicine, which aims to treat each patient individually.

How Could a PGx Test Benefit Me?

The reason most people get PGx tests is so their medical provider will have the best possible information they can have regarding how their unique body metabolizes various medications. As a result, your medical provider can prescribe the most effective medications, at the most effective doses, with the least amount of risk for adverse drug reactions.

How PGx Tests Are Helping People

How and Where is the pGx test administered?

The test is conducted by collecting your DNA sample. This is usually a simple cheek swab, an oral rinse, or saliva collection. It can be administered at your provider’s office by any member of their staff. It can also be administered by your Personal Healthcare Advocate, or even done by you yourself in the comfort of your own home.

How do i know if i qualify for a pGx test?

There are multiple factors that can qualify you for a PGx test. However, a licensed medical provider will determine whether or not you have a medical necessity, and be the one to authorize your test. You are certainly justified to request a PGx test from your medical provider. However, not all tests are created equally, so please get in touch with your ACG Personal Healthcare Advocate, who can assist you in getting the most comprehensive test in the industry.  Here is a list of some reasons that may justify medical necessity:

  • When the FDA requires/recommends pharmacogenomics (PGx) testing for a medication
  • When the patient has had a severe adverse drug reaction(s) or complications due to medications
  • There is a family history of a serious adverse drug reaction or known pharmacogenomic variant
  • Identifying patients who require a higher or lower-than–standard dose of a medication
  • When patients have experienced multiple treatment failures
  • The recommended drug dosage has not relieved symptoms or the patient has sensitivity to a medication
  • When a patient is experiencing unexpected or exaggerated response(s) to a medication(s)
  • To improve a patient’s medication compliance/adherence
  • For patients who are on multiple medications
  • PGx testing can be taken preemptively so the results can be readily available when needed

How does the testing process work?

How Much will the PGx Test Cost Me?

Genetic testing is considered preventive care. Insurance will typically cover the entire cost of the test if you meet the medical necessity requirements, so there would be no out of pocket costs for you in most cases.

The lab will check with your insurance company to make sure they will cover the test. If your insurance company will not approve the test, or not agree to cover the entire cost, the lab will contact you with further options. Again, they will not automatically process the test and hold you responsible for the cost.
 

Testing is also available for those who are uninsured and/or those who wish to self-pay for the test. Please check with your personal healthcare advocate advocate or medical provider for further details on pricing.

what if my medical provider won't authorize my test?

Your Doctor should certainly want the most and best information available to manage your treatment and not cause you any unintended harm.  Pharmacogenomics testing can help eliminate “trial and error” prescriptions and the common “one size fits all” medication management of the past. It can also help improve patient care, satisfaction, and confidence, as well as ensure compliance and reduce your provider’s risk of liability. Your medical provider will most likely authorize your test as long as you have a medical necessity. 

If your medical provider will not agree to authorize your test, it may simply be because they are not as educated as other providers in this area, or they believe you don’t have a medical necessity. If this is the case, your ACG personal healthcare advocate can help you locate a provider who understands the value and importance of this test and would authorize it for you if you have a medical necessity.  Remember…your doctor works for you, and can be fired by you if you feel they are not doing their very best to treat you.

What leading providers are saying about pGx Testing

What about the DNA testing scams I've heard about in the news?

Just like in any business or company, unfortunately, there are occasional bad apples in the bunch. Some dishonest people have decided to use this fairly new market as a cover to steal unsuspecting people’s identities. There are also other deceitful people whose intention is to defraud insurance companies by circumventing the rules and regulations.  

This is a very highly regulated industry, and you should only be dealing with licensed medical providers or HIPAA certified personal healthcare advocates who are well versed in the compliance guidelines set forth by CMS and the OIG. It is best to avoid door-to-door solicitors for any type of medical genetic testing. If anyone ever offers you money to sign forms to take a DNA test, please report them to the U.S. Department of Health and Human Services Office of the Inspector General by calling 1-800-447-8477.

will my results affect my health insurance or employment?

Your results will NOT affect your health insurance or employment, thanks to a law passed in 2008. The Genetic Information Nondiscrimination Act (GINA) of 2008 protects Americans from discrimination based on their genetic information in both health insurance (Title I) and employment (Title II). For more information about the Genetic Information Nondiscrimination Act, go to http://www.ginahelp.org

I want my own PGx test. How do I get one?

Contact the ACG Personal Healthcare Advocate, medical professional, or pharmacist who directed you to this information, and they will walk you through the process to ensure you will receive your own PGx test if you are eligible.