CommercialCoverageMedium impact
Pharmacogenetics 2.02.30
Excellus BlueCross BlueShield·Neurology, Oncology, Hematology +2 more·Genetic Disease (Inherited Disease)
Effective date
Feb 20, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their pharmacogenetics policy effective February 20, 2025, establishing specific coverage criteria for genetic testing to guide drug selection and dosing. The policy covers CYP450 genotyping for certain conditions like Gaucher disease and Huntington disease, while considering most other pharmacogenetic testing investigational.
Action Required
By February 20, 2025: Review current pharmacogenetic testing orders and ensure proper medical necessity documentation. Update billing processes to verify that CYP2D6 genotyping is only billed for Gaucher type I patients considering eliglustat or Huntington disease patients considering tetrabenazine >50mg daily. Flag CYP2C9 genotyping as potentially covered only for multiple sclerosis patients starting Mayzent. Document that TPMT testing requires prior azathioprine/6-MP therapy initiation or failed standard dosing.