BlueCross BlueShield of Tennessee Medical Policy Manual

Pharmacogenetic Testing for Pain Management

DESCRIPTION

Pharmacogenetic testing combines pharmacology and genomics for the intent of developing effective and safe medications and doses tailored to a person’s genetic makeup.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

No controlled studies were found in the published literature that validates the use of pharmacogenetic testing for the treatment of pain. No published studies were found reporting outcomes for patients managed with pharmacogenetic testing for pain management. Therefore, the clinical utility of such testing cannot be determined.

SOURCES 

American College of Preventive Medicine. (2009) Genetic testing clinical reference for clinicians. Retrieved April 23, 2015 from http://www/acpm.org/?GeneticTestgClinRef.

Bell, G. C., Donovan, K. A., & McLeod, H. L. (2015). Clinical implications of opioid pharmacogenomics in patients with cancer. Cancer Control, 22 (4), 426-432. (Level 4 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual. (11: 2015). Pharmacogenic testing for pain management. (2.04.131). Retrieved May 2, 2016 from BlueWeb. (53 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. LCD for pathology and laboratory: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing (L35660). Retrieved March 14, 2017 from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35660.

Crews, K. R., Gaedigk, A., Dunnenberger, H. M., Leeder, J. S., Klein, T. E., Caudle, K. E., et al. (2014) Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update. Clinical Pharmacology & Therapeutics, 95 (4).

Jannetto, P. J., & Bratanow, N. C. (2009). Utilization of pharmacogenomics and therapeutic drug monitoring for opioid pain management. Pharmacogenomics, 10 (7), 1157-1167.

Kapur, B. M., Lala, P. K., & Shaw, J. L. (2014). Pharmacogenetics of chronic pain management. Clinical Biochemistry, 47 (2014), 1169-1187.

Scarpi, E., Calistri, D., Klepstad, P., Kaasa, S., Skorpen, F., Habberstad, R., et al. (2014). Clinical and genetic factors related to cancer-induced bone pain and bone pain relief. Oncologist, 19 (12), 1276-1283.

U. S. Food and Drug Administration. (2004, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. k042259. Retrieved April 24, 2015 from http://www.fda.gov/cdrh/pdf4/k042259.pdf.

Winifred S. Hayes, Inc. Genetic Testing Evaluation. (2014, November). Cytochrome P450 genotyping to predict response to opioid pain medications. Retrieved April 15, 2014 from www.Hayesinc.com/subscribers. (44 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  9/13/2015

MOST RECENT REVIEW DATE:  5/11/2017

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.