At the time of recording, Colleen Keenan was a consultant with Advisory Board’s Clinical Innovators Council, a membership group for researchers designed to help suppliers strengthen their relationships with integrated delivery networks and their providers. Colleen had been with Advisory Board for over four years and has worked in several areas, including pharmacy and devices. She recently left Advisory Board to pursue graduate studies.
Pharmacogenomics
Pharmacogenomics (PGx) is the process of identifying any issues or predispositions in a person’s DNA that could adversely affect the medications they take. This field of research is incredibly timely and worthy of attention from pharmacy leaders.
With a growing audience and the beginning of an understanding of PGx, there is a need to make it more accessible and bring together stakeholders from across the healthcare system. Pharmacy leaders and their healthcare counterparts need to understand how PGx can enhance their care, and what their role in the process is. This tool requires collaborative, cross-disciplinary working, new programs as well as educating patients.
There are three main areas where the value of PGx has already been demonstrated. First and foremost is in oncology. Cardiovascular diseases and mental health, specifically depression and anxiety issues, also benefit from PGx. Those three areas are where the most investment has been made and evidence shows the efficacy. Correspondingly, that also makes insurers more likely to cover testing in those areas. A fourth pseudo-category is walk-in patients who are curious to understand their genetic makeup and are willing to pay out of pocket for the test. The potential reach is much bigger than these four categories. For example, 99% of US veterans carry at least one actionable PGx variant that affects drug efficacy.
The importance of using PGx information to improve patient health outcomes is more promising than ever, but why is inclusion in the health system still lagging?
Challenges of PGx implementation in health systems
One challenge for PGx programs is that different clinicians can use the same word to mean different things. For instance, pharmacogenomics is looking at the entire genome, whereas pharmacogenetics really looks at a single gene or a single set of genes. What is called a pharmacogenomics program might actually be a pharmacogenetics program, where they’re testing either a single gene or a smaller panel of genes, rather than the entire genome. There are many nuances like that, but most of it is semantics. The acronym PGx can refer to either. When people are talking about pharmacogenomics, they might mean pharmacogenetics, but they have the same goal in mind: to understand a patient’s genetic makeup to inform better prescribing decisions.
If different stakeholders have a common language, they can talk about it the same way, which will advance the field faster. Through Colleen’s work with Advisory Board, a permanent interactive glossary focused on some of the most commonly confused terms in relation to PGx, as well as terms that are inherently important for understanding the process, was implemented. We’re not at a place where PGx is widespread just yet, so stakeholders have to start at the foundation before they can build it up across the country and the world.
Some people think that there is tension between PGx and the idea of care variation reduction. However, personalized medicine can help reduce some of that unexpected care variation happening down the line. As well, PGx programs aren’t widespread enough to make standardization our main priority, though there are groups and coalitions which aim to start the standardization process in order to ensure that a system is in place once PGx is widespread enough.
The biggest challenge is reimbursement. Reimbursement in the PGx space mostly centers on a few use cases. If you’re not an academic medical center that could fund it on their own, or if you don’t have patients who are willing to pay out of pocket, it’s hard to get enough reimbursement to cover the costs of launching a program. Health systems are doing it because it’s the best thing for the patient. However, because of the reimbursement challenge, not every health system can do it just because it’s the right thing to do.
There is a bit of growth in the provider space within primary care, but it’s hard to get leadership buy-in for a program if you’re not seeing a lot of the return on it. Once you do get that buy-in, there are so many moving pieces to work out ahead of time to make sure that process flows smoothly. For example, another challenge is making sure that you can have a way to integrate those PGx results into the EHR in a way that is actionable and easy to understand. This is a challenge that companies like GenXys are solving through EHR-interoperable software that helps healthcare professionals, including physicians and pharmacists, use PGx results more easily.
A pharmacist’s role in implementing pharmacogenomics
Pharmacists can play a major contributing role to PGx programs: they wield huge clinical impact through a lot of initiatives like medication reconciliation, diabetes management, and medication therapy management. Pharmacists play a central and integral role in patient care, and in the field of personalized medicine, specifically PGx , the reach is exponential.
Pharmacists typically spend more face-time with patients than their primary care provider; they are a trusted resource for patients and have a huge knowledge base. This makes them a great partner to help manage patients with chronic conditions or comorbidities.
(Want to learn more? Check out: The Pharmacist’s Role in Implementing Pharmacogenomics [Podcast])
Pharmacogenomics adoption during and beyond COVID-19
As the world is slowly recovering from COVID-19, could the pandemic accelerate the wider adoption of pharmacogenomics?
This research by Advisory Board on pharmacogenomics was started in early 2020, but there is an intersection between PGx and potential COVID-19 related applications. One example relates to helping providers identify drug-gene interactions tied to some of the experimental COVID-19 treatments that we were seeing earlier on in the pandemic. Another application is understanding the patient’s genetic makeup to determine how likely they are to contract the virus and/or how severe their form of the virus would be. Another application surrounds the aftermath of the pandemic as we’re seeing an increase in diagnoses of depression and anxiety. PGx can help get patients on the right medication faster, which reduces costs and time for health systems and providers. The pandemic has shown that PGx can be an opportunity to help those clinicians provide more targeted treatment and make more precise prescribing decisions.
(Watch these explainer videos created by Colleen and her team: 4 things you need to know about pharmacogenomics.)
Conclusion
Because PGx is still not as widespread as it could be, the work that Colleen’s team does to make the topic approachable for everyone involved is crucial in furthering its adoption. Leaders who are on the cutting-edge of health systems are embracing PGx. Now is the time to support the engagement of PGx and EHRs and pursue the advancement of reimbursement.
Thank you, Colleen, for joining us on Precision Insights!
About Precision Insights Podcast
The Precision Insights podcast is a podcast series consisting of inspiring conversations around precision medicine with industry thought leaders and innovators. Every two months (and sometimes more), we share the most cutting-edge technologies, processes, and initiatives in precision medicine. If you’re a patient, healthcare provider, healthcare executive, employer, or someone simply interested in precision healthcare, you’re sure to find something useful in each episode. We hope that you’ll join our listeners and start taking control of your health, or implement precision health into your workplace/health system as a result!
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