Pharmacogenetic testing can produce significant results for plan members, but it isn’t appropriate for everyone and should never be looked at in isolation, according to a panel discussion at Benefits Canada‘s Face to Face Drug Plan Management Forum.
Speaking on the panel in Toronto on Dec. 5, Mark Faiz, chief executive officer of Personalized Prescribing Inc., said the testing is designed to code a person’s DNA using their saliva to look for specific genes.
“Different tests will test for different genes and so, the idea of the probing is to discover which one of these genes have mutated,” said Faiz. “And the reason is that if a gene has mutated, the outcome of the drug that is trying to produce the outcome for the patient changes.”
Aside from the emergence of new capabilities in this area, there are two forces driving interest around pharmacogenetic testing in the group benefits space, said Julie Gaudry, senior director of group insurance at RBC Insurance, during the panel discussion.
The first, she said, is that plan sponsors are seeing a rise in drug claims costs and are looking to insurance providers to help them manage the increase. There has also been a move towards a more personalized approach to health care. “I think those two forces, coupled with the advancements in the science around pharmacogenetics, are causing us to think about it a little bit more.”
Faiz cautioned that the test isn’t designed for every situation, noting it should only be used if a medication fails. “Then the doctor should be prescribing [it].”
Also speaking on the panel, Dr. Sidney Kennedy, a professor of psychiatry at the University of Toronto, said the test examines pharmacokinetics (what the body does to a drug) and pharmacodynamics (what the drug does to the body). “The issue here is about the difference among all of us in the number of variants in some of these cytochrome enzymes in our liver,” he noted.
Kennedy noted only 10 per cent of the population are either poor drug metabolizers, with almost no enzyme to metabolize the drug, allowing side-effects to build up quickly, or ultra rapid metabolizers, who will break down the drug so quickly that it can’t reach an adequate therapeutic level.
Speaking on the panel, Priscilla Po, director of drug plan management and employer health solutions at Shoppers Drug Mart and Loblaw Companies Ltd., said the test is just one piece of information to be considered among a number of complex factors. “You really need to look at the patient’s condition, their medication profile, perhaps if there’s a test available. They need to take in all the different information in order to make a decision on medication change, if it is warranted.”
Gaudry said many insurers are wondering where pharmacogenetic testing fits within benefits plans, including making it an eligible expense to all plan members or specifying situations where claimants may consider having a test done.
“We have to figure out the right fit, the right criteria, when to use that, and . . . we’re trying to contribute to that information as we gather real-time experience as our plan members begin to use the tests themselves.”
The industry has started with pilot projects, mostly in the disability management space, with individuals who aren’t responding to medications, said Gaudry. “Is there an opportunity to adjust their medication to be better suited for them, perhaps expedite recovery and return to work? That makes perfect sense of a place to test something out like this.”
While Faiz said he doesn’t expect pharmacogenetic testing will have a big impact on the cost of drugs in workplace benefits plans, he does believe it will help plan members get on the right drug. “That will result in better productivity, lower absenteeism [and] probably prevent some disabilities.”
But there are still hurdles, according to Gaudry, who referred to communicating the availability of pharmacogenetic testing with plan members, assessing their willingness to use it and then taking action on the results.
“If we can find a way to deliver that, in a simplistic way for plan members to feel comfortable moving forward with it, or in the right setting, perhaps in a disability management setting or within a prior authorization approach for specialty medication, I think that there’s a real opportunity there.”
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