Plan sponsors looking to integrate pharmacogenetic testing into their benefits plan will soon have lots of information to consider as Canada’s biggest insurance companies roll out pilot projects and research begins to shed light on the return on investment.
“The market is expanding. Insurers are piloting projects. You will hear a lot about pharmacogenetics over the next 12 months,” said Valerie Charlebois, senior associate for health and benefits at Mercer, during a session on pharmacogenetics at the Human Resources Professionals Association conference in Toronto on Wednesday.
Mental health is the main area that pharmacogenetic companies are focusing on, she said, noting it’s a huge cost driver for employers when it comes to disability, absenteeism and drug programs. “Mental health is the leading cause of employer long-term disability programs,” said Charlebois. “It’s also likely in the top two, maybe three, drug categories under your plan.”
She referred to a 2013 U.S. study that showed employees taking the wrong medication are three times more likely to be absent from work and four times more likely to be on short- or long-term disability. “There’s a need and there’s a context and there’s an opportunity, and there’s this fantastic science that is starting to come in and fill some of that need,” said Charlebois.
“If I can determine, in advance, how I will react to certain medications, that potential is huge. And if employees need the treatment, to help them have access to that information in advance of the treatment, forgo the trial-and-error approach, it’s pretty significant stuff.”
Research in the United States is showing a reduction in symptoms and cost as a result of offering pharmacogenetic testing to patients, said Charlebois. “So if employees know what their test results are and their physicians know, prescribing practice changes and costs are going down.”
While a study on pharmacogenetic testing has been underway at the Centre for Addiction and Mental Health since 2013, Charlebois said that with the technology still being new in Canada, there hasn’t yet been a proven return on investment. But a number of pilot projects by the country’s largest insurers could change that soon.
Sun Life Financial has partnered with CAMH for a study that targets patients on short- and long-term disability. Great-West Life Assurance Co. launched its pilot project in December 2017 with a focus on chronic pain and mental health. And Manulife Financial Corp. will roll out a pilot project later in 2018 that focuses on chronic pain, anxiety and antidepressant medications.
“Where insurers are going and getting after this for employers is the potential to shorten the duration of disability claims. A secondary benefit is that the drug costs might reduce, but the focus is really on how to reduce disability claims,” said Charlebois.
“They’ve said, ‘This is where we think this science is going to impact change,’” she added.
For plan sponsors considering integrating pharmacogenetics testing into their benefits plans, there are a number of options. First, they can consider adding it into the disability claims process by offering a voluntary test as part of the treatment path, said Charlebois.
They can also introduce it in the same style as an employee assistance program where they pay a provider a monthly amount and then employees can access the program as needed, she suggested. “So you can implement that on an EAP-style monthly premium or you can pay as you go. The group rate per testing is considerably less than the individual market right now. It would be more like $300, as opposed to $300 up to $1,000, if you’re implementing on a pay-per-use option.”
Pharmacogenetics testing is eligible as a medical expense under the Income Tax Act, which means it’s possible to claim it under a health-care spending account, Charlebois noted.
“So you can add those immediately without all the other considerations: Is this something we want to launch to everyone as a new benefit or will we let people know they can claim this under an existing HSA? You can do that right now. Insurers might put reasonable and customary limits on the testing . . . but you do have that option.”