Though physicians prescribe a standard drug dose which tends to work for most patients, some will experience severe side-effects whereas others will experience no benefit at all. Some of these patients are working individuals. At Personalized Prescribing, we are actively working with employers and disability managers, who are using pharmacogenomic testing to help these employees.
In our experience, a pharmacogenomic test is not necessary for everyone. It is beneficial for those who are having major problems with their medications. The test has the most impact for employees who struggle with mental health and chronic pain, where the traditional approach is months-years of trial and error, lost productivity, and disability. For employees on psychiatric medications, cost-savings both to payers and employees can amount to $3,988/person/year, as substantiated by the literature1.
Not all tests are equal. Most are pharmacogen-e-tic, testing a handful of genes in isolation. We find that is not enough. We have decided to go pharmacogen-o-mic, whereby we test multiple genes to determine response. In addition, our experience has taught us that employers can get the greatest ROI from a pharmacogenomic benefit when it includes a medication evaluation. With the growing opioid crisis and the incoming legalization of marijuana, a comprehensive medication evaluation can facilitate the de-prescribing of high-risk medications and provide medication education.
At Personalized Prescribing, we offer employees a pharmacist-guided medication evaluation service, the first of its kind. Our pharmacists evaluate the genetic results within a larger context, including clinical factors. While we provide the standard long digital reports that others provide, our pharmacists also conduct research to provide customized recommendations. They generate a concise summary report, indicating to the physician which of the employee’s current medications to continue/discontinue, along with alternatives. We have found that this report was better received by the busy physicians, and we have seen measurable results in terms of improved employee outcomes.
We are currently working with employers to institute robust employee education campaigns. We realize that there is some apprehension with regards to genetic testing. It is important that employees are made aware that all information is kept confidential and there is no genetic discrimination (in accordance with the Canadian Genetic Anti-Discrimination Act). We do not assess predisposition to disease. We only test the genes involved in medication response to help employees and their employers.
1- Brown, L. C., Lorenz, R. A., Li, J., & Dechairo, B. M. (March 01, 2017). Economic Utility: Combinatorial Pharmacogenomics and Medication Cost Savings for Mental Health Care in a Primary Care Setting. Clinical Therapeutics, 39, 3, 592.