Personalized medicine is no longer the stuff of science fiction. A simple cheek swab determines which medications will work best based on your genetics—and which ones to avoid.
Pharmacogenetic testing is a game-changer not only for plan members who can get on the right medication from the start, but also for plan sponsors who no longer need to cover the costs of medications that didn’t work.
“We’ve been talking about how to remove waste from the pharmaceutical system for years and years. This is a really safe, clear, transparent, and smart way to do it,” said Gavin Mosley, Group Benefits Consultant with Mosley Group Benefits in Kanata, Ontario, during a recent Benefits Alliance Voice podcast, “Employee DNA Can Lower Benefits Plan Costs.“
Mosley Group began socializing and piloting pharmacogenetic testing with plan members and plan sponsors several years ago. The verdict? Two thumbs way up.
“We’ve seen the direct impact with clients. We really feel diagnostics like this are the way of the future of pharmaceuticals,” said Mosley. “Benefits plans aren’t going to cover a lot of high-priced drugs without one of these [tests].”
He added that pharmacogenetic testing is “an actuary’s dream” from a group-insurance perspective. “It’s a one-time charge and low risk. It is not a big recurring claim.”
For example, the Pillcheck pharmacogenetic testing service is priced at a lower rate of $500 when accessed through the workplace. Plan members receive the test in the mail, do their own cheek swab and mail the test back to Pillcheck. Hundreds of drugs are assessed for the most common conditions, including in the areas of mental health, cardiovascular health and pain management. The resulting report clearly identifies which drugs are good or bad matches based on the person’s DNA. Plan members regularly receive updated reports, at no extra cost, as new medications become available.
More on the ROI
An independent study on the impact of pharmacogenetic testing found that 78 per cent of existing prescriptions had to be adjusted, most often by switching to another medication. For people struggling with anxiety or depression, the changes in medication accelerated recovery by an average of 10 weeks.
Pharmacogenetic testing and other diagnostic tools “are strategies that you can actually see a true ROI,” said Rob Green, Regional Director, Eastern Canada, Acera Benefits, during the podcast.
Behind those results are many difficult and even tragic stories of preventable adverse reactions to medications. “[They] really emphasize how important it is just to have a baseline of your DNA so you know, even before you need medications, what to do and what are the safest choices for you,” Dora Chan, a pharmacist consultant for Pillcheck.
Awareness and coverage
When Mosley first raised awareness of pharmacogenetic testing and promoted its coverage through health spending accounts (HSAs), utilization tended to be reactive. “I would get calls from plan members asking about coverage for certain DINs before getting a prescription for that…but the one that’s covered may not be a good fit genetically.”
Today, Mosley works with plan sponsors and insurers to include pharmacogenetic testing in the plan design, starting with its inclusion in benefits booklets and portals. The test should be seen as part of anyone’s healthcare journey, he noted. When an illness or accident occurs, “recovery often includes a prescription and to me PGx testing really is a baseline coverage…especially since it’s a one-and-done.”
“Everybody is looking to be proactive with their health more than ever before,” added Green. “But most people aren’t aware of these options. As an employer, [you raise awareness] just by making these options available, even on a voluntary basis, and saying, ‘Hey, we have access to this unique pharmacogenetic test.’ More people will be interested than not.”
Educational webinars—which can be facilitated by your benefits advisor—can be a great way to engage employees and explain how to access pharmacogenetic testing, said Mosley. He also encouraged his peers—and plan sponsors—to walk the talk before speaking with plan members. “It’s powerful when you do it yourself…and can speak to it,” said Mosley, who did his own test six years ago. “Once you see your [results] you want everyone in your family to have one…before they’re prescribed something.”