How Payers Can Leverage Precision Medicine, Pharmacogenomics
Payers and other stakeholders are starting to see the value of precision medicine and pharmacogenomics, but advancing these fields will require stakeholder coordination.
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- Precision medicine and pharmacogenomics are on the rise and could unlock solutions for many of the perennial challenges in healthcare, but these fields demand a coordinated effort between payers, pharmacists, providers, and other stakeholders in order to serve members and employees well.
Cynthia Yu, PharmD, director of precision medicine at The Profero Team, noted the various benefits of precision medicine.
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“Precision medicine—as far as pharmacogenomics, specifically—is really beginning to blossom,” Yu said on Healthcare Strategies.
“It's very exciting as healthcare providers are beginning to accept the utility of the pharmacogenomics, rather than looking at it as something foreign and difficult and something to kind of have to hurdle or worry about sitting there in the background.”
Scott Betzelos, MD, chief medical officer and vice president of HMO strategy and affordability at Blue Care Network, added that precision medicine has a lot of potential for oncology specifically and an even broader impact outside of pharmacogenomics through whole-genome sequencing and tumor mutational burden.
But despite these benefits, Betzelos and Yu acknowledged some barriers to precision medicine’s advancement.
“One of the things that the payers experienced, unfortunately, over the last few years is the unbundling of a platform of pharmacogenomics (PGx) testing,” Betzelos explained.
“So they test you for one gene or a second gene or third gene, and you add the cost up to that. And it's more than the single cost of an entire platform of tests. And it ends up being a waste of funds that are used in PGx testing. So I think it is very important to reduce the incidence of unbundling.”
Both Yu and Betzelos also noted the challenge of—and the demand for—creating an EHR that smoothly integrates pharmacogenomics data into its design.
Betzelos shared how Blue Care Network plans to incorporate pharmacogenomics into its set of solutions for members through its partnership with a precision medicine vendor.
“The ability to over-communicate with both the provider and the patient in terms of how best to manage this, and then the connectivity between specialty groups,” Betzelos shared. “The prescriber very often is not handling the specific disease process that the gene-drug interaction occurred, so we want to have that communication between specialties and then, underlying it all, it's really pharmacist intervention that helps support the program.”
For payers and employers who may be hesitant about providing coverage for precision medicine or how to leverage pharmacogenomics for their members and employees, Yu had a few suggestions.
She urged payers and employers to assess whether their member and employee populations need pharmacogenomics. If so, they should then identify high-quality labs with clinician decision support, integrate the pharmacogenomics data into member EHRs, and pair pharmacogenomics testing with chronic disease medication management.
