Pharmacogenetic testing’s place in long-term disability programs

Plan sponsors and insurers are increasingly wading into the waters of pharmacogenetic testing by offering the service to employees making long-term disability claims.

In 2017, Sun Life partnered with the Centre for Addiction and Mental Health for a pilot project that offered pharmacogenetic testing to plan members on disability leave due to a mental-health condition. After seeing positive results, it embedded pharmacogenetic testing into its disability management toolkit.

Read: Pharmacogenetic testing a growing area as pilot projects, research get underway

Indeed, the majority of Canadian insurers have undertaken pilot projects to explore this emerging technology, with a focus on testing plan members with chronic pain and/or mental-health issues, says Sandra Ventin, associate vice-president of benefits at Arthur J. Gallagher & Co.

Pharmacogenetic interests

65% of plan sponsors are interested in providing coverage for pharmacogenetic testing.

74% of plan members would consent to pharmacogenetic testing.

Source: 2019 Sanofi Canada health-care survey

“We’re still early days. A lot of the insurers are still in pilot-program mode instead of a go-forward approach, [but ] he early results have been encouraging.”

Marie-Chantal Côté, vice-president of market development at Sun Life, says about 90 per cent of the insurer’s eligible plan members agreed to participate in its pilot project. On average, patients experienced a 31 per cent reduction in their symptoms after their treatment was guided by the testing. “We have a high plan member engagement, which tells us that plan members want to be empowered to help make decisions about their medication regime.”

Opportunities, challenges

GE Canada and Staples Canada are among the employers offering pharmacogentic testing to plan members as a pilot project. In 2018, GE’s pilot included 10 employees who were on short-term disability. In the same year, Staples Canada introduced a pilot to help employees get back to work more quickly by finding the most effective medications for them.

Read: A look at one company’s experience with pharmacogenetic testing

Pharmacogenetic testing, which is done typically via a cheek swab, analyzes a person’s genetic makeup to find out how they’ll respond to a certain drug. It’s a way to ensure an individual gets on the right medication at the right time, says Côté. “The advantages include helping [individuals] and their physicians find an effective treatment faster, allowing them to return to work sooner, cost savings for the benefits plan and, ultimately, reduced costs related to absenteeism and disability for the employer.”

The tests, which are usually ordered by a patients’ physician, generally cost between $250 and $500, says Fatima Di Biase, a principal and consultant in Mercer Canada’s health and benefits business. Since testing involves patients and their physicians, it’s key that both parties are on board, she adds. “Patients [are] not always fully understanding the test itself and, specifically, understanding how the test is going to be shared, and that’s concerning for certain individuals, and rightly so.”

There has to be clear communications to plan members, says Di Biase, not only about the science but to allay potential fears around confidentiality. “The other challenge is really the adoption and application of some of these tests by the physician community because it’s really a newer area for the general practitioner community. So it’s taking time for them to understand and interpret the findings and knowing how to collaborate with other practitioners on what the ultimate therapy is going to be based on what the tests tell them.”

Read: Sun Life to look at effectiveness of pharmacogenetics on plan members

Despite the challenges, Côté believes more insurers and plan sponsors will dive into using pharmacogenetic testing, not only when plan members are on long-term disability, but in order to prevent disability leaves. “We believe there will be a continued interest for pharmacogenomics in disability claims management. We also believe there will be interest in pharmacogenomics as it relates to early intervention and prevention with respect to being on an effective medication at the onset of any mental-health issue.”

Melissa Dunne is the former managing editor of Benefits Canada.