Wondering about insurance coverage
and reimbursement for pharmacogenetic testing?
Wondering about insurance coverage and reimbursement for pharmacogenetic testing?
Insurers recognize the clear benefits of pharmacogenetics in optimizing treatment, minimizing side effects, and helping reduce medication waste and disability. The Pillcheck pharmacogenetic service is available for purchase directly by consumers, and there are several options to help you save on the out-of-pocket expense. The following guide provides tips and resources for determining if you have coverage and taking advantage of member benefits that may be available to you.

Extended Health Benefits
Check your plan information for pharmacogenetic testing coverage. It is often listed under “laboratory diagnostic testing” and may be called "pharmacogenomic testing.” Some insurers require your doctor to requisition or prescribe the test for you to be eligible for coverage under extended health benefits. If your doctor writes a prescription for you, make sure it indicates “pharmacogenetic testing” and your diagnosis. Or, ask your doctor to complete this requisition form.

Healthcare Spending Accounts
Pillcheck is eligible for reimbursement through a health spending account. A Health Care Spending Account (HCSA), also known as a Health Spending Account (HSA), is an individual employee account that provides reimbursement for a wide range of eligible healthcare expenses that are not covered under provincial health insurance plans or other benefit plans.

Preferred Pricing
Pillcheck is available at a preferred price for members of many organizations. Check your organization’s member website to access the member discount and learn more about their coverage or reimbursement options.
Determining your coverage
If your plan information doesn’t mention pharmacogenetics, you can submit information about Pillcheck to the insurer or plan administrator to confirm coverage. Insurance companies generally outline the process for doing this in plan materials. Our requisition form describes essential details they may need to determine if you’re covered.
Reimbursement
After you order Pillcheck and receive your results, we will provide you with a receipt listing the pharmacist who provided your medication review. Use this receipt to submit for reimbursement. Pillcheck does not submit reimbursement claims on your behalf.