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.
FAQ
Is Pillcheck covered by provincial health insurance in Canada?
Although most provincial health insurance plans do not cover pharmacogenetic testing, each province/territory varies, so check with your provincial health insurance to see if you might be eligible for coverage.
Does Pillcheck need to be ordered by my doctor?
Individuals may purchase a Pillcheck test without a doctor’s order. However, a doctor’s prescription or requisition for the test may be required for reimbursement through your health insurance. Be sure to check with your plan before ordering to understand any requirements or limitations for pharmacogenetic coverage.
Does Pillcheck submit claims for reimbursement?
Each customer is responsible for submitting their claim for reimbursement from their benefits or insurance provider. Pillcheck does not submit insurance claims on behalf of customers. Before ordering Pillcheck, check with your insurance provider to confirm that pharmacogenetic tests are covered under your benefits plan.
Can Pillcheck be claimed as an eligible medical expense on my tax return in Canada?
Yes. Pillcheck is an eligible medical expense as defined in Canada’s Income Tax Act. Pillcheck is a clinical-grade pharmacogenetic test, and results are reviewed and summarized by a licensed pharmacist.
How much does Pillcheck cost?
Pillcheck costs $599 + tax (CAD). Preferred pricing may be available through your benefits or healthcare provider.
Will Pillcheck impact my insurance coverage?
Health benefits and insurance companies may cover the cost of the Pillcheck service as an optional benefit.
Your personal health and genetic information will be kept confidential and will never be shared with your employer, insurer, or any third party without your consent. Additionally, it is illegal under the Genetic Non-discrimination Act to use genetic information for insurance underwriting or employment. Therefore, Pillcheck results do not impact a person’s insurance or employment.
For more details, please refer to our Privacy Policy and Consent Form.
How does Pillcheck ensure that my personal information is kept private?
Pillcheck promises to keep your personal and genetic information confidential.
Here’s what we do:
- Destroy your genetic sample after your report is complete
- Ensure your genetic data is not linked to your personal information in our system
- Allow you to decide who you share your results with
- Follow Canadian, U.S., and international health information privacy and security guidelines
- Samples processed, and all data stored in Canada
- None of your personal health and genetic information will be shared with your employer, insurer, or any third party without your consent
- The test is not designed to assess disease risk, disease diagnosis, or ancestry
For more details, please refer to our Privacy Policy and Consent Form.