Luis Fong
I am what you might call a first responder in mental health — a psychiatric nurse practitioner based in Gilbert, providing care to patients of all ages through a virtual collaborative care model and in-person across Arizona. My goal is simple: I want my patients to get better. I want them to enjoy their lives and enjoy their families.
But we’re falling short on mental health in our state.
18% of adults in Arizona have been diagnosed with depression — 9th in the U.S.
Arizona is ranked #50 / 51 in mental health prevalence and access to care.
The traditional “trial-and-error” approach to prescribing mental health medications can result in frustration – as well as wasted time, money, and medication – for clinicians and patients. Less than 40% of patients with depression achieve remission with their first prescribed drug. With each new medication, the chance of remission decreases, while treatment intolerance increases, according to a large study.
Mental health disorders are complex and challenging to treat, but there is a tool that can help, and Arizona already passed a law to support it. To help treat my patients, I often utilize mental health pharmacogenomic (PGx) panel tests. These biomarker tests require only a simple cheek swab to analyze a patient’s DNA. The results of the test, which only needs to be administered once in a patient’s life, provide genetic insights that help me understand how a patient may metabolize or respond to commonly prescribed psychiatric medications. In my practice, I have seen how this information can allow me to tailor treatment plans, reduce side effects, and avoid the frustrating trial-and-error process that can delay recovery
In 2022, Arizona was one of the first states in the nation to pass legislation (House Bill 2144) requiring Medicaid and commercial insurance plans to cover qualified biomarker tests for a variety of conditions, including mental health. Biomarkers are biological indicators — such as genes, proteins or other molecules — that provide information about a person’s health or response to a treatment.
House Bill 2144 created a unique opportunity for Arizonans suffering from mental illness by requiring that personalized medicine tools, like mental health PGx panel tests, be made widely available to better treat mental health disorders when they are covered under Medicare coverage determinations. By requiring health insurance carriers to cover this type of biomarker testing, the Arizona Legislature has signaled its intention to improve access to mental health care in the state. Based on AHCCCS’ published medical policy and the experience in my clinical practice, more than two years after the legislation has been in effect, Arizona’s Medicaid Fee for Service Program — AHCCCS and the Medicaid Managed Care health plans that contract with AHCCCS — to provide care to Arizona Medicaid patients are not adequately covering mental health PGx panel tests that clearly should be covered under the law.
One such example is the GeneSight Psychotropic Test which had its medical billing code listed on AHCCCS’ fee schedule even before the biomarker law went into effect — allowing coverage of the test by the state Medicaid program and managed care programs. After the law went into effect, however, AHCCCS abruptly removed the code without explanation, effectively designating this Medicare-covered, clinically validated, and legally required biomarker test as a non-covered service for Arizona’s Medicaid population.
Meanwhile, PGx mental health panel testing remains covered by Arizona commercial insurers, creating a disturbing disparity in access for Medicaid patients, who are often among the most vulnerable and most in need of effective mental health care. Adding insult to injury, coverage is already available to our closest neighbors under both Medicaid Fee for Service and commercial health insurance.
This is troubling for me and for my patients. As mental illness continues to exact a heavy toll on Arizona and the United States, we should be doing all that we can to seek out and increase access to proven solutions. We cannot afford to squander opportunities to improve access and treatment for mental health care while so many Arizonans are desperate for relief. I am looking to state agencies and policymakers for leadership to ensure that health insurers are following the law. I urge Arizonans to contact the Governor’s Office, AHCCCS, or their state legislator to ask them to support broad access to mental health PGx panel tests that meet the biomarker law’s coverage requirements.
Luis Fong is a board-certified family psychiatric mental health nurse practitioner at Spero Psychiatry and Counseling, providing comprehensive psychiatric care to people throughout Maricopa County.