It’s Official: CMS Will Not Reimburse Medicare Recipients for Genetic Warfarin Dxs

By Kirell Lakhman

It’s official: CMS will not reimburse Medicare recipients for genetic warfarin-dosing tests.

According to G-2 Reports, CMS recently concluded in a final decision “there was not enough evidence” to show that pharmacogenomic testing of the CYP2C9 and VKORC1 alleles “to predict responsiveness to the anticoagulant drug improves health outcomes in Medicare beneficiaries.”

The final decision went into effect Aug. 3, but “the agency left the door open to reconsider based on further evidence development,” G-2 says.

The agency said genetic testing “is not reasonable and necessary” — two criteria for coverage — reiterating a proposed ruling it made in May, according to Sample sister publication Pharmacogenomics Reporter.