Using Pharmacogenetics to Improve Health Care and Control Costs

Have you ever taken a medication that didn’t work or, worse, made you sicker? Maybe you had to throw away a bottle of pills and go back to your doctor to get a prescription that finally helped you feel better.

Even though medications often work as intended, sometimes they don’t, launching patients into what can be a lengthy process of finding the right medication. It can be a waste of both time and money, not to mention the physical toll on the patient. Depending on the condition, some patients can potentially avoid that trial-and-error process thanks to the study of pharmacogenetics.

Using Pharmacogenetics to Improve Health Care and Control Costs

“Pharmacogenetic Testing: A Key Strategy for Optimizing Your Health Care Spend” is one of five sessions now available on the Prescription Drug Management Virtual Conference. Presenter Jennifer K. Fuhrmann-Berger, Pharm.D., describes the concept of pharmacogenetics and suggests how health plans could use it to improve patient outcomes and control health care costs. Fuhrmann-Berger is senior vice president of clinical services at BeneCard PBF, a pharmacy benefit manager based in Mechanicsburg, Pennsylvania.

What Is Pharmacogenetics?

Pharmacogenetics (PGx) is the study of how a person’s genetic makeup influences his or her response to medication, considering differences in genes, metabolism and environment. By understanding how an individual will metabolize medication, prescribers can make informed decisions and prescribe effective medications at accurate doses the first time they see a patient looking for help with a condition.

“It’s a way to personalize health care and get patients on the right medication at the right time, eliminating inappropriate and ineffective medication utilization,” Fuhrmann-Berger said.

Evidence, Insight and Strategy for Optimizing Health Benefits

PGx testing has the potential to:

  • Maximize the intended use of a medication or treatment
  • Speed time to achieving the therapeutic benefit of a drug
  • Reduce adverse drug reactions
  • Decrease the chance of side effects or dependency
  • Reduce health care costs.

How Does Pharmacogenetics Work?

A plan participant takes a mouth swab of saliva and sends the sample to a lab that specializes in performing pharmacogenetic tests. The lab generates a report that shows whether the individual is a good metabolizer or poor metabolizer of up to 150 medications, depending on the test, provider or lab.

The results often come back in a report that looks almost like a traffic light. The red drugs are drugs the participant can’t metabolize, the yellow drugs may require increased or decreased dosages to work effectively, and the green drugs will work best for the participant’s metabolism.

The participant takes part in a clinical consultation where a pharmacogenetics-certified pharmacist helps them understand any impact to their medications. Then the patient can work with his or her health care provider, care coordinators and pharmacogenetic experts to find the right medication without a lengthy and potentially harmful period of trial and error. Pharmacogenetics information can guide the prescribing of a wide range of medications, including those that treat common conditions such as high cholesterol and diabetes, but also opioids, anesthetics, pain medications and cancer drugs, in addition to expensive specialty medications.

[Related Reading: 17 Ways Employers Are Combating Prescription Drug Costs]

What Should Plan Sponsors Know?

Because pharmacogenetic tests can cost hundreds of dollars and are applicable only to specific medications and conditions, plan sponsors need to consider where the tests can offer the most value.

Fuhrmann-Berger recommends that plan sponsors begin by having a pharmacist look at their participant population to identify high-cost claimants, those with chronic conditions and those experiencing serious drug side effects. From there, testing might be offered to participants who are taking statins, antiplatelet medications, drugs for mental health and specialty medications. Plan sponsors also might concentrate on members who are taking a high number of different medications, or members with higher levels of drug spending, in an effort to ensure that these patients are receiving effective treatment at a reasonable cost.

While pharmacogenetic testing is a relatively new concept and is not yet a standard offering from pharmacy benefit managers or health insurers, it may become a viable cost-control option as drug costs continue to increase and research in the field advances.

Want to Learn More?

Enroll now in the Prescription Drug Cost Management Virtual Conference to have full access to the recorded sessions, covering pharmacogenetic testing, PBM contract negotiations, specialty drugs and improving prescription drug adherence.

Prescription Drug Cost Management Virtual Conference

Kathy Bergstrom, CEBS
Kathy Bergstrom, CEBS
Senior Editor, Publications, at the International Foundation

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