UnitedHealth Group Covers PGx Testing: What Employers Need to Know

UnitedHealth Group Covers PGx Testing: What Employers Need to Know


In August, the UnitedHealth Group announced that it would provide insurance coverage for pharmacogenetic (PGx) testing based on specific criteria. Starting this month, their official policy will come into effect. UnitedHealth now covers PGx tests for patients with major depressive disorder or anxiety, who have experienced treatment failure at least once. Many other insurers have already followed suit.

The goal is to offer effective medications for individuals and save up to $6,000/per participant in the first year of treatment. 

What does this mean for employers? 

As leading insurance companies have come to realize, there is a real clinical benefit in using PGx for optimized and personalized treatment options. It is high time to think about your role in the adoption of PGx testing to help improve both your employee’s health and the company’s bottom line. So, let’s get started by looking at why PGx is a viable solution for helping you keep your employees healthy and productive. 

PGx Testing: The Practical Solution for Employee Wellness

Combat Rising Employee Health Costs


The average total health benefit cost per employee rose 3.6% in 2018, according to a recent Mercer Survey. More specifically, prescription drugs are the top cost driver for many companies. On average, the cost growth is 3.3% per year—and you can control this rate.

Finding new ways to control rising healthcare costs is more critical than ever. One practical approach is the use of PGx testing as part of your employee health solution. 

So, what’s the benefit of PGx testing? 

When PGx results are used by a healthcare professional to help guide prescribing, it can be a cost-effective way to provide employees with the right medication options at the right time based on their unique genetic makeup. This precise method means less time and resources spent on the traditional ‘trial and error’ approach to prescribing. 

Irrespective of the number of employees you have, the costs from ineffective treatments and prolonged absenteeism and presenteeism, can add up significantly. However, with insights from PGx, your employees can get better and make productive contributions faster. Healthy employees are your most valuable assets, and in the long run, their performance will significantly impact your bottom line. 

Help Employees Tackle Chronic Health Issues

UnitedHealth Group’s updated policy focuses on specific conditions, such as depression and anxiety, but the value of pharmacogenetic information goes far beyond those conditions. You can find the most recent PGx information and associated health conditions on FDA drug labels and literature created by pharmacogenetic and academic organizations like CPIC and PharmGKB

Chronic conditions are among the costliest health conditions in the United States. Why is this so important for employers? Having employees with chronic conditions can mean decreased productivity and increased absenteeism resulting in higher disability claims.

The Centre for Disease Control and Prevention estimates that chronic disease costs employers $225.8 billion annually in lost productivity. One reason is that employees with multiple chronic conditions are absent for more days compared to their colleagues. The longer employees are absent from work, the harder it is to stay on top of work responsibilities.

How can PGx help?

PGx offers a promising solution, enabling a higher quality of care and better-targeted therapies for chronic health conditions. With enhanced care, there will be fewer employees on sick leave, shorter duration of absenteeism, and reduced disability claims in your workplace. PGx testing helps get employees on safer and more effective medications, allowing them to improve and return to work faster.

(Related Post: Managing High-Cost Claims with Precision Prescribing

Prevent Employees from Adverse Drug Interactions


Many of your employees are taking at least one prescription drug. The right medication can be life-changing, but only if prescribed, and taken correctly. Each year, 4.5 million hospital visits are attributed to adverse drug reactions 

Dangerous drug interactions influence 10% of direct healthcare costs, and 50% of adverse drug reactions could be prevented every year. PGx testing helps healthcare providers prescribe the right medication and dosage for your employees based on their genetics.

Getting your employee’s medication right from the beginning will help your employees avoid drug safety issues. Avoiding harmful drug interactions can improve employees’ overall well-being and save their lives in the worst cases.

What Are My Next Steps as an Employer?

Although the costs for PGx testing have been decreasing in recent years, tests not covered by insurance still present a cost barrier for Americans. This reason, coupled with healthcare providers’ lack of clinical ability to integrate PGx results into prescribing decisions and the limited usability of some PGx reports, has hindered the adoption. Many people rely on insurance coverage to get access to valuable medical services like PGx.

This limitation will now change with UnitedHealth Group’s updated policy covering PGx testing. Health insurers and employers are seeing the value that PGx testing is bringing to the workplace, and we are expecting to see more insurers following this trend. The integration of PGx test results into prescribing is also improving with PGx results being directly digitally integrated into the prescribing process through the use of leading clinical decision support software—a.k.a. precision prescribing applications.

As the industry continues to evolve, you can start preparing for what’s to come. 

Here’s how: 

Stay up to date on news and studies on PGx that can help you build a strong case for your employee’s wellness. Here are some publications to get you started:

Consider adding pharmacogenetic testing into your employee benefits package to ensure employees have the best chance of getting accurate prescriptions

Following these steps can go a long way toward a healthier, more productive workforce—a bottom-line impact for you and your team.

Final Thoughts 

It will take some time to understand how greatly PGx will impact the employee benefits landscape. A few things for sure: rising employee health costs, increasing prevalence of chronic conditions, and continuing adverse drug interactions are serious concerns in the U.S workforce. The use of PGx for prescribing is a credible and proven solution to help alleviate and curtail these concerns.

Moreover, ensuring that PGx is reimbursable will play a primary role in accelerating its adoption across the care continuum. The digital transformation and integration of PGx data into the healthcare provider’s current workflow will also play a significant role. By incorporating PGx data directly into the prescribing process, healthcare providers can take a holistic approach and take each employee’s genetics, biophysical, and other factors into account. 

For the first time, PGx data is no longer a standard 50-page report that health providers struggle to use effectively in a 10-12 minute consultation. PGx data is now real-time information that is clinically relevant and useful.

By being proactive in understanding how PGx works, you’ll prepare your organization for the future. 

Next Step 

Ready to learn more about how pharmacogenetics can help your company reduce healthcare costs and boost your employee’s health? 

Download our free resource: Pharmacogenetics for Employers Webinar Series 

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