Pharmacogenomics is the study of genetic differences in metabolic pathways which can, and oftentimes do, affect individual responses to drugs, both in terms of therapeutic effect as well as adverse effects. Pharmacogenomics has been characterized as “getting the right dose of the right drug to the right patient at the right time.” This test will give physicians and their patients’ critical insights into drug effectiveness, potential side effects, and adverse drug reactions before prescribing medications. Recent studies have shown that pharmacogenetic testing (PGx) can decrease healthcare costs while simultaneously improving clinical outcomes. There is no medication trial and error period. 2.2 Million people suffer severe adverse drug reactions (ADR) per year. ADRs are the third leading cause of death in the U.S. and prescribed drugs causing severe reactions or death are the cost leader for malpractice payouts.
Ancillary Medical Solutions has partnered with Medkinect to provide an exemplary solution which allows physicians to capitalize on their Pharmacogenetic Testing. In the traditional model, physicians bill a CPT code which is the procedural code and may or may not be reimbursed. With our platform, the physician will still bill their CPT code, but will be provided a Non-Pharmacy Dispensing Site Number (NPDS) and will bill the Wet DNA kit using its National Drug Code (NDC) number. Pharmacogenetic Wet kits are reimbursable for any patient with pharmacy benefits. Pharmacogenomic testing can be reimbursed by insurances once in a lifetime. All insurances are accepted for the test, except HMO at this time. Medicaid does reimburse in selected states.
Total start-up is a nominal $550.00 and the reimbursement opportunities are exponential. Our partner provides both a dry and a wet kit. The wet kit, which has an NDC number is what the physician needs to utilize in order to recoup substantial reimbursement. Our partner will offer 45 day terms and $10,000.00 credit on the initial order to a practice. The initial order will have zero up-front cost. This provides the practice a time period to capture reimbursements before finalizing payment.
Health Care Provider Revenue: Realistically at five (5) wet kits/week (minimal) averaging $425.00 per test, the practice could easily gain a minimum of $8500.00/month. How we arrived at that number: Average Wholesale Price = $804.00 X 80% avg. reimbursement = $644.00 less $200.00 cost of kit and $19.00 processing fee = $425.00 net to the physician. Our solution offers a turn-key approach for the clinician to capitalize on their Pharmacogenetic Testing – easy to implement and easy to use.
Until now there has been little opportunity for physicians to gain financial benefit from Pharmacogenetic testing. This solution enables the doctor to profit from the testing. The information gathered as a result of the testing has the potential to reduce many major adverse drug reactions.
We also provide an injectables program with 25 “Injectables Kits” that operates on the same PBM platform and can enhance reimbursement on routine steroid and pain injections.
For additional information on how to get these programs into your practice, please contact Ancillary Medical Solutions at: Jbleich@ancillarymedsolutions.com.