Drug-gene testing now covered by Medicaid

Jan. 30--LIMA -- A form of genetic testing designed for patients taking prescription medications is now covered by Medicaid, and is being offered by a growing number of physicians in northwest Ohio.

Pharmacogenetics, or drug-gene testing, is a genetic test that helps doctors and patients determine which prescription drugs they should take and which they should avoid based on their genetic makeup. The test also determines the proper dosage that's appropriate for each patient.

The test, now offered by nine medical providers in Lima, Bluffton and Findlay, analyzes 25 genes within the human body.

"The more genes you test, the more drugs you cover," said Jeff Reichardt, a northwest Ohio representative of MedXPrime, a patient care company that works with pharmacogenetic testing labs. "This is a comprehensive test that can analyze 5,000 drugs, even what I call 'orphan drugs' that are not typically taken by the average Joe."

Reichardt said the test, which requires a simple cheek swab, is covered by most private insurance companies, Medicare and most recently, Medicaid. If a patient has a private insurance company, the test is subject to deductibles and co-pays. For those with no insurance, the out-of-pocket cost is $650 for the one-time test.

With Medicaid, however, there is a catch.

"You can't just go in and say 'I want the test' if you have nothing wrong with you because Medicaid's not going to pay for it," Reichardt said. "But if you're already on medications, then you have a medical need and you can get the test through Medicaid."

Reichardt said pharmacogenetic testing has come about due to the amount of adverse drug reactions patients are having throughout the U.S. According to the Food and Drug Administration, 100,000 people die each year from adverse drug reactions, and 2 million are hospitalized.

Reichardt believes these statistics would dramatically decrease if physicians were mandated by the federal government to offer the test.

On Wednesday, Reichardt met with Ohio state Rep. Matt Huffman to discuss the possibility of creating a "guidance letter" that would do just that.

"We're not ready to announce anything yet, but we did meet with him and he had his legislative assistant hook us up with the Medicaid legislative assistant," he said. ""We're going to meet with them face-to-face to see about creating a guidance letter demanding that anyone who treats Medicaid patients must at least offer the test."

Reichardt hopes pharmacogenetic testing will become "standard practice" at medical centers in Ohio and across the U.S.

"If it's financially possible for you to do this, it can be a standard of care," he said. "Every patient needs to have this test because it can save lives and save billions of dollars in unnecessary hospital admissions."

Reach John Bush at 567-242-0456 or on Twitter @bush_lima

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