Prescribing medication can be a trial-and-error process: Doctors prescribe medications that are indicated to treat their patients’ ailments. The medications often work, but sometimes they don’t.
With so many medications being offered today, it has become more important than ever to consider the side effects and the reactions that may occur when an individual is prescribed more than one medication. Modern science has allowed doctors to be able to take preventative action with testing to help determine if one will have a negative reaction to a certain medication.
What is Pharmacogenetics?
Pharmacogenetics is the study of how a person’s genetic makeup influences his or her response to medication, considering differences in genes, metabolism, and environment. Pharmacogenetics enables treatment to be tailored to the individual, delivering the right medication and the right dosage at the right time. It can eliminate the waste and frustration of the typical trial-and-error approach to finding an effective medication.
While many might think pharmacogenetics only applies to complex medications such as biologics, pharmacogenetic data can guide the prescribing of a wide range of medications, including those that treat common conditions such as high cholesterol and diabetes. The data can also be used in prescribing of opioids, anesthetics, pain medications and cancer drugs, in addition to expensive specialty medications.
How Testing is Conducted
Testing can be conducted in a few different ways: through a blood test, saliva test, or cheek swab1. These tests are then mailed to a highly advanced diagnostic laboratory that specializes in performing genetic tests. The report generated from the results indicates whether the member is a good metabolizer or poor metabolizer for up to 150 medications, depending on the test, provider or lab. Because genetic makeup doesn’t change, the report can be used not only for current health conditions and medications but also can help to determine the most effective drugs for conditions the individual may develop later in life.
Benefits of Pharmacogenetics
By understanding how a member will metabolize medication, prescribers can make informed decisions and prescribe medications at accurate doses for the first time the member visits them looking for help with a condition. This improves health outcomes and reduces costs.
In the case of a ten-year-old patient who was diagnosed with Leukemia, pharmacogenetic testing was used prior to treatment to ensure the best care. The patient underwent blood testing to see how he would respond to certain cancer treatments. These results revealed that the young patient was “one of the 10% of Caucasians with a genetic variation that reduced his ability to metabolize thiopurines, the drugs most commonly used to treat acute lymphoblastic leukemia”2. Based on the results from pharmacogenetic testing, he was given a lower dose of treatment so that his body could properly process his treatment, and as a result, he is now in remission2.
Pharmacogenetics data can also be integrated as part of standard point-of-sale drug utilization review. This enables the pharmacy benefit manager’s (PBM) system to alert the dispensing pharmacist at a retail pharmacy when a medication is contraindicated because the patient cannot metabolize the medication – before the pharmacy dispenses the drug. This simple check can reduce waste, increase quality of care and deliver plan savings.
According to a study by Drexel University College of Medicine, medication errors, which refers to prescribing the wrong medication, the wrong route or dose, or the wrong frequency, account for 7,000 to 9,000 deaths per year in the United States. Additionally, hundreds of thousands of other patients experience but often do not report an adverse reaction or other medication complications. By applying pharmacogenetic testing to the health care delivery process, patients could avoid taking medications that may do more harm than good. This can reduce errors in prescribing and reduce fatalities or significant harm to the patient.
Who Should Get Tested
Pharmacogenetic testing can cost hundreds of thousands of dollars per test, so it is likely not feasible to offer testing to all plan participants. Plan sponsors might instead consider offering tests only to plan members with complex health conditions or others who are most likely to receive significant benefit from the investment.
One possible strategy is to focus on members who rely on medications that have a significant impact on long-term disease such as hepatitis C, cancer, cardiovascular disease, and diabetes. Plan sponsors might also focus on members who are taking a high number of different medications or members with higher levels of drug spending in an effort to help reduce their expenses.
According to the Agency for Healthcare Research and Quality, 1% of people account for more than 24% of total health care expenditures. By helping these patients find better solutions to their health care needs through pharmacogenetics, providers can reduce these expenditures, saving money and reducing waste at all levels of health care.
What About Privacy Concerns?
The discussion of pharmacogenetic testing often includes a question of member privacy. It is important to understand that this testing looks at genetic factors that affect metabolism and not the deeper details of genetic makeup or DNA. This is not the same type of genetic testing conducted to decipher genotype or the likelihood to develop cancer based on genetic and hereditary considerations.
Pharmacogenetic testing is, however, personal and, along with all genetic data, is protected by the Genetic Information Nondiscrimination Act of 2008 (GINA), the federal law that protects individuals from discrimination based on genetic information by both health insurance providers and employers.
Pharmacogenetic testing is not yet standard offering in the healthcare industry. However, as drug costs continue to increase and research in the field advances, plan sponsors may wish to consider it as a viable cost-control option.
For more information, see the below resources:
1.https://medlineplus.gov/lab-tests/pharmacogenetic-tests/
2.https://www.nature.com/articles/537S60a
3.https://www.ncbi.nlm.nih.gov/books/NBK519065/
4.https://meps.ahrq.gov/data_files/publications/st546/stat546.pdf