The 2014-2016 Boom Bust in Pharmacogenetics Spending at Medicare

These are some 2018 slides of me, which convey the "boom bust" in pharmacogenetics spending at Medicare Part B around 2014, 2015, 2016.  The codes for PGx (like CYP2D6) were new in 2013, paying about $100M.   (In prior coding, this would have been methods "stack coding.")

In 2014, payments shot up to $300M plus - as the codes had no controls or edits (no policies).  Policies providing only limiting coverage for PGx were rolled out in 2015 and fully in place by 2016.   Payments fell over 90%.  This ended the "autopay" period.

As a footnote, total MoPath payments were level, around $600M, in 2014, 2015, and 2016.  As the pharmacogenetics payments fell (shown in yellow below) a range of other codes came on board (shown in purple below, e.g. more use of BRCA testing and other codes).