Xact Laboratories, LLC

Jerry Wrobel

John P Pigott

Rob Todd

System and methods for alerting a healthcare provider to prescribed treatments having reduced or no effectiveness due to genetic composition is provided. A database containing treatments known to have reduced or no efficacy in persons having particular genetic markers is queried to determine whether any treatments prescribed by, or likely to be prescribed by, a healthcare provider to the patient are known to have reduced or no efficacy in persons having the same certain genetic markers as the patient. An alert indicating such information is displayed at a healthcare provider system.

System and method for alerting providers to ineffective or under effective treatments based on genetic efficacy testing results

System and methods for automating preauthorization of genetic efficacy testing with prescription dispensation are provided. Coverage requests for medicines are received from pharmacy systems. Databases are queried to retrieve policy rules for the coverage requests. A coverage decision analysis is performed and where an associated medication is otherwise approved for coverage and where genetic efficacy testing is available for the associated medication, a prior authorization for such genetic efficacy testing is automatically generated and included with which is transmitted together with an approval of coverage decision to a requesting one of said number of pharmacy systems.

Automated prior authorization for genetic efficacy testing with prescription dispensation

System and methods for suggesting insurance eligible genetic tests to a healthcare provider are disclosed. An EMR system is queried to retrieve insurance information, active medications, and diagnoses associated with a particular patient. An eligibility database is queried to retrieve insurance eligibly rules for a particular policy of a particular insurance providers based on the retrieved insurance information. A laboratory information system ('LIS') applies the retrieved insurance eligibility rules to the retrieved active medications and diagnoses to determine eligible genetic tests. An electronic notification comprising an order form for each of the eligible genetic tests is transmitted from the LIS to the EMR.

System and method for suggesting insurance eligible genetic efficacy tests

A system and method for alerting a healthcare provider to ineffective prescribed medications is provided. A laboratory system receives test results with genetic markers for a patient, queries a database containing medications known to be ineffective in persons having particular genetic markers to determine whether any medications prescribed by, or likely to be prescribed by, a healthcare provider to the patient are known to be ineffective in persons having the same genetic markers as the patient, and transmits an alert containing such information to a healthcare provider system for the healthcare provider.

System and method for determining the effectiveness of medications using genetics

System and methods for preventing the coverage or fill of ineffective medications are provided. Genetic efficacy testing results are received at a pharmacy benefits manager ('PBM') system from a laboratory information system. Medications reported as ineffective in the testing results are flagged as an allergy in an electronic patient record. Requests for coverage of medications are received at the PBM system from a dispensing pharmacy system and electronic notifications are issued to the dispensing pharmacy system where the medication is flagged as an allergy at the PBM system to prevent the flagged medication from being filled.

Preventing the fill of ineffective or under-effective medications through integration of genetic efficacy testing results with legacy electronic patient records

System and methods for alerting a healthcare provider to prescribed treatments having reduced or no effectiveness due to genetic composition is provided. A database containing treatments known to have reduced or no efficacy in persons having particular genetic markers is queried to determine whether any treatments prescribed by, or likely to be prescribed by, a healthcare provider to the patient are known to have reduced or no efficacy in persons having the same genetic markers as the patient. An alert containing such information is displayed at a healthcare provider system.

System and method for genetic based efficacy testing

System and methods for providing laboratory-based authorization of genetic testing are disclosed. An order for genetic testing is received from an electronic health record ('EHR') system at a laboratory information system ('LIS'). A prior authorization request is automatically generated at the LIS from data parsed from the order and retrieved from the EHR and sent to a prior authorization provider. If a patient responsibility amount returned to the LIS is below a threshold, testing proceeds. If the patient responsibility amount is above the threshold, an electronic call center request is generated and the patient is contacted to obtain payment. If a billing consent is not obtained, the specimen for the order is destroyed.

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Aurora, OH, United States of America

Jerry Wrobel