Dx Test Order
Write
Script
Post-Dx Test
Return Visit
Fill Script
Are the physician and
patient willing to wait for
the test result?
How does the test affect
the physician's willingness
to order the drug?
Dx Test Coverage
Dx Test Prior
Authorization
UM: Formulary Tier
UM: Step
Edits
Is the physician willing to
complete prior authorizations
for the test and drug?
How does the test affect
UM for the drug?
Coordination
How will the drug and test
payers coordinate their
access policies?
Would restrictive test
coverage impede access to
the drug?
Dx Test Results
Dx Test Verification
Process
(Drug Prior
Authorization
Equivalent)
How does the drug payer
get the test results?
Is the physician willing to be
the conduit for sending the test
results to the drug payer?
Dx Test Payment
Copay/Coinsurance
for Dx Test Order
Copay/
Coinsurance
for Drug
Drug
Payment
Is the patient willing to accept
the out-of-pocket cost for the
test?
Is the test payer willing to
reimburse enough for the lab
to perform the test profitably?