Demystifying Medicaid Coverage and Reimbursement for Pharmacogenomics Testing | Precision Health and PGx Podcast

In this episode, Dr. Mary Weissman, Dr. Lexi Wensel, and Dr. Becky Winslow discuss Medicaid’s coverage of pharmacogenomics testing and Medicaid’s reimbursement of a pharmacist’s time spent provisioning PGx testing and providing PGx inclusive medication therapy management for Medicaid beneficiaries. We teach the listener how to locate, navigate, and understand Medicaid-managed care organizations’ coverage and reimbursement policies for pharmacogenomics testing and the billing codes pharmacists can use to bill for their time in providing PGx testing. Lastly, we analyze pharmacists' time investment versus Medicaid reimbursement of the pharmacists' time to project the financial return on investment of this business model for pharmacists.  

 

After listening to this episode, the listener will understand what Medicaid and Managed Care Organizations (MCOs) are and their role in pharmacogenomics utilization; understand how to navigate managed care organizations' policies to determine coverage for pharmacogenomic testing and eligibility criteria; recognize the current Medicaid coverage landscape for pharmacogenomic testing, including eligibility criteria, coverage limitations, and variations across different states; and understand pharmacists' roles in the provision of pharmacogenomics testing and Medicaid’s reimbursement of a pharmacists’ time.