Abstract
The nation's largest private health insurer, UnitedHealthcare, announced that beginning October 1, it will cover testing that will allow physicians to match patients to the antidepressant and antipsychotic medications most likely to work for them based on their genetic profiles.
The positive coverage decision was good news for makers of the multi-gene panel tests, including Myriad Genetics.
“We're very excited that the nation's largest private health insurer has issued a positive policy decision supporting the advance of precision medicine in mental health,” said Ron Rogers, spokes-person for Myriad, in an emailed statement. “Today's decision is validation of the need for pharmacogenomic testing in mental health and is a recognition of the important role that genetics plays in medication response.”
UnitedHealthcare's policy specifies that the use of pharmacogenetic multi-gene panels to guide therapy decisions is proven and medically necessary for antidepressants and antipsychotic medication when the following criteria are met:
The individual has a diagnosis of major depressive disorder or anxiety; and
The individual has failed at least one prior medication to treat their condition; and
The multi-gene panel has no more than 15 relevant genes
“Up to 42 percent of variance in therapy response for major depressive disorders can be explained by genetic variation, which has led to the development of pharmacogenetic tests to inform the use of certain psychiatric medications. Prospective randomized clinical trials have been performed to validate the clinical validity and utility of a number of pharmacogenetics multi-gene panels,” the new policy reads.
Depression is the leading cause of disability worldwide according to the World Health Organization. An estimated 17.3 million (7.1 percent) adults in the United States had at least one major depressive episode in 2017, according to the National Institutes of Mental Health. Treatment-resistant depression is especially difficult for patients and their families as well as a significant financial cost to the U.S. healthcare system.
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