GeneSight at CAMHP
The GeneSight® Psychotropic test looks at how a person’s genes may affect how they respond to medications used for mental health conditions. The report sorts medications into color-coded categories — green “Use as Directed,” yellow “Moderate Gene-Drug Interaction,” and red “Significant Gene-Drug Interaction” — so the ordering clinician can use the results, along with everything else they know about the patient, to help inform prescribing decisions.
The two white papers on this page are published by GeneSight (Myriad Genetics, Inc. / Myriad Neuroscience). They are reproduced here for patient and clinician education, and each paper is linked to its original at genesight.com. GeneSight® and Myriad Genetics are registered trademarks of Myriad Genetics, Inc.
What the GeneSight Test Costs
GeneSight bills your insurance for the cost of the test. Here is the cost picture, from GeneSight’s own financial information sheet for patients:
- Medicare (Part B) and Medicare Advantage: covered tests are $0 out of pocket.
- Medicaid: covered tests are $0 out of pocket.
- Commercial or other insurance: $330 or less.
- Uninsured / self-pay: the reduced self-pay option is $330, open to every patient.
Financial assistance: GeneSight offers a financial assistance program based on household income and household size, under federal guidelines. Patients with federally funded insurance (Medicare, Medicare Advantage, Medicaid, TRICARE®, VA) are not eligible for the assistance program. If your cost is $100 or more, GeneSight also offers an interest-free payment plan that spreads the cost over several months.
How billing works: when GeneSight receives your sample, they confirm your cost — and contact you first if it could be over $330. They then process the test and bill your insurance. You may receive an Explanation of Benefits (EOB) from your insurance company; an EOB is not a bill. Your actual bill comes from GeneSight after the claim is finished, and billing can take several months.
Download GeneSight’s Financial Information Sheet (PDF)
Full details and a cost estimator: genesight.com/cost • GeneSight Customer Service: 866-757-9204 • Fax 888-894-4344. Out-of-pocket figures above are from GeneSight’s review of 12 months of past claim data for major U.S. insurance carriers (sheet GSAP.009.263, ©2026 Myriad Genetics, Inc. / Assurex Health, Inc.).
White Paper 1 — How Can I Use the Clinical Considerations to Help Interpret the GeneSight Report?
Source: GeneSight white paper, “How can I use the clinical considerations to help interpret the GeneSight® Psychotropic report?” — Read the original at genesight.com. Sent to CAMHP by GeneSight in the email “Understanding the GeneSight® Psychotropic Report” (October 21, 2026).
Introduction
Pharmacogenomic reports contain a lot of useful information. Sometimes there is so much information the report can seem overwhelming. To overcome this issue and to increase the clarity of the results for both healthcare providers and patients, the GeneSight test employs a user-friendly software-based product to report the results in an easy-to-read way. The GeneSight report categorizes medications into intuitive, color-coded categories based on an individual’s genetic results. These include the green “Use as Directed,” yellow “Moderate Gene-Drug Interaction,” and red “Significant Gene-Drug Interaction” categories.
What are clinical considerations and what is their clinical significance?
All medications start out in the green category on the GeneSight test. Based on an individual’s genetic variation, a medication may be moved out of this category, and into the yellow or red category, depending on how significantly the variation is expected to impact outcomes with that medication. Medications on the GeneSight report are labeled with one or more of the ten possible clinical considerations, which explain the rationale for a medication’s classification and can be used to help inform treatment decisions.
How do I interpret each clinical consideration?
Clinical considerations:
- Serum level may be too high, lower doses may be required.
- Serum level may be too low, higher doses may be required.
- Difficult to predict dose adjustments due to conflicting variations in metabolism.
Clinical considerations 1 and 2 reflect an issue with how the medication is metabolized. This means that the individual has variation in one or more of their pharmacokinetic genes. This may affect how much medication is in an individual’s system and may require a lower or higher dose, respectively. Clinical consideration 3 indicates that there are conflicting variations in the metabolism of that medication, thus making it difficult to predict a dose adjustment. The most common example is when there are two genes that contribute a relatively similar amount to the overall metabolism of the medication, but one has increased activity and the other has decreased activity.
- Genotype may impact drug mechanism of action and result in moderately reduced efficacy.
Medications labeled with clinical consideration 4 are affected by a pharmacodynamic gene, and thus reflect an issue with the drug’s mechanism of action. Variation in these genes predicts a moderately reduced response to certain medications. Since pharmacodynamic genes do not affect metabolism, it is unlikely that adjusting the dose will improve efficacy.
- CYP2D6 genotype indicates that this patient may experience increased frequency of side effects but also greater symptom improvement in those who find the treatment tolerable.
Clinical consideration 5 specifically applies to atomoxetine (Strattera®) when a patient is a CYP2D6 poor metabolizer. This is based on evidence which shows that CYP2D6 poor metabolizers treated with atomoxetine experienced an increased frequency of side effects but also significantly greater improvement in ADHD symptoms compared to extensive (normal) metabolizers.1
- Use of this drug may increase risk of side effects.
Clinical consideration 6 indicates that an individual may have an increased risk for side effects when taking this medication. This can be due to variation in one or more pharmacokinetic genes that may predict slower than normal metabolism of certain medications, which may result in higher levels of medication in the system. It could also be due to an effect caused by one of the pharmacodynamic genes.
- Smoking status changes the results of this medication. See next section labeled Smokers for smoking results.
Clinical consideration 7 specifically applies to individuals who have the highly inducible variant of the CYP1A2 gene, which may result in increased activity for CYP1A2 when the patient is a smoker. This increased activity may change how this medication is metabolized. For individuals who are smokers, it is important to refer to the results in the following section labeled Smokers.
- FDA label identifies a potential gene-drug interaction for this medication.
- Per FDA label, this medication is contraindicated for this genotype.
When medications are labeled with clinical consideration 8, it alerts the healthcare provider and patient that the FDA has made a statement in the package insert that may have pharmacogenomic implications for a person with this genotype taking this medication. Clinical consideration 9 indicates that the FDA has declared this medication contraindicated for a person with this genotype.
- While this medication does not have clinically proven genetic markers that allow it to be categorized, it may be an effective choice based on other clinical factors.
Clinical consideration 10 is associated with medications in the gray “No Proven Genetic Markers” category, meaning that genetic markers have not yet been discovered to reliably predict which genes are involved in the metabolism and/or therapeutic efficacy of these medications. Due to this lack of evidence, we are not currently able to categorize them or provide actionable recommendations.
Conclusions
Clinical considerations provide valuable information about a medication’s classification. Healthcare providers can rely on these to help them think about how to potentially use a medication that is affected by genetic variation. Clinical considerations can also be used to help guide discussions with patients about treatment decisions.
Reference: 1. Michelson, D. et al. CYP2D6 and clinical response to atomoxetine in children and adolescents with ADHD. J Am Acad Child Adolesc Psychiatry. 46(2), 242-251 (2007).
White Paper 2 — How Do I Use the Gene-Drug Interaction Chart?
Source: GeneSight white paper, “How Do I Use the Gene-Drug Interaction Chart?” — Read the original at genesight.com. Sent to CAMHP by GeneSight in the same October 21, 2026 email.
What is the gene-drug interaction chart?
Healthcare providers and patients often inquire about how they can determine which genes may affect outcomes with each medication. The gene-drug interaction chart provides supplementary information about which pharmacokinetic genes are involved in the metabolism of each medication. It is not mandatory to refer to the gene-drug interaction chart when using the GeneSight® test to inform patient medication selection. It is simply intended to augment the patient results on the interpretative pages, which serve as the primary resource to help inform treatment decisions.
How do I interpret the gene-drug interaction chart?
The pharmacokinetic genes on the GeneSight report are listed across the top of the chart, and medications are listed in a column on the left side. Any dot (either shaded, unshaded, or half-shaded) signifies that the enzyme is involved in the metabolism of the associated medication. A shaded dot means that variation was found in the patient’s genotype that may impact medication metabolism. An unshaded dot indicates that the gene is associated with medication metabolism, but the predicted patient phenotype is normal. A half-shaded dot means that the phenotype is dependent upon smoking status, with smokers being ultrarapid metabolizers and non-smokers being normal metabolizers. Medication categorization in this chart is according to non-smokers. Refer to the sections labeled Smokers to see medication categories for individuals who smoke.
Why do I sometimes see shaded dots for medications that are in the green “Use as Directed” category?
When you see shaded dots in the green “Use as Directed” category, it means that although the patient has variation in one or more genes, it is unlikely to impact their metabolism of that particular medication. This could mean that while an enzyme is involved in the metabolism of the medication, its role is not clinically significant enough to warrant a change in dosing. For example, buspirone (Buspar®) is metabolized by CYP3A4 and CYP2D6.1–3 Since CYP2D6 plays a very minor role in Buspar® metabolism, variation in this gene will not likely change the way Buspar® is metabolized, and therefore Buspar® will remain in the green category even when CYP2D6 has a shaded dot.
Another reason a medication in the green category could have shaded dots is that the enzymes involved have opposite phenotypes and therefore compensate for one another. For example, vilazodone (Viibryd®) is metabolized by three different enzymes: CYP2C19, CYP3A4, and CYP2D6.4 In the example below, the patient is ultrarapid for CYP2C19, poor for CYP2D6, and extensive (normal) for CYP3A4. Since CYP2C19 and CYP2D6 have phenotypes in opposite directions, the enzymes very likely compensate for one another, and Viibryd® remains in the green category.
Why are there sometimes no dots for medications in the red “Significant Gene-Drug Interaction” category?
In this uncommon situation, the medication does not have any known pharmacokinetic markers but does have pharmacodynamic markers. Since the gene-drug interaction chart includes only pharmacokinetic genes, the medication will not have any dots. Thus, the reason the medication falls in the red category is due to the effect of the pharmacodynamic gene. The only medication on GeneSight Psychotropic that creates this situation is oxcarbazepine (Trileptal®).
Conclusions
The gene-drug interaction chart provides additional information to healthcare providers and patients about which pharmacokinetic genes are involved in the metabolism of each medication. The GeneSight test takes into consideration the unique metabolic pathways and mechanisms of action for each medication and integrates genetic information from all relevant pharmacokinetic and pharmacodynamic genes to categorize medications into the green, yellow, and red categories.
References: 1. FDA Label. Buspirone. (2010). 2. M. Zhu, W. Zhao, H. Jimenez, D. Zhang, S. Yeola, R. Dai, N. Vachharajani, J. M. Cytochrome P450 3A-mediated metabolism of buspirone in human liver microsomes. Drug Metab. Dispos. 33, 500-507 (2005). 3. N. Raghavan, D. Zhang, M. Zhu, J Zeng, L. C. CYP2D6 catalyzes 5-hydroxylation of 1-(2-pyrimidinyl)-piperazine, an active metabolite of several psychoactive drugs, in human liver microsomes. Drug Metab. Dispos. 33, 203-208 (2005). 4. FDA Label. Vilazodone. (2011).
Ask CAMHP about GeneSight
GeneSight results are one part of a full clinical picture. Your CAMHP clinician reviews the report with your history, your current medications, and how you have responded to treatment before any prescribing decision is made.
Or email camhp@camhp.us with the subject line “GeneSight Question.” Please do not email medical records or other private documents until a secure way to send them has been arranged with you.