Saving $$s through pharmacogenomics

Pharmacogenetic-guided treatment has the potential to personalize medicare care and reduce cost

Doing the right thing the right way — hopefully right out of the gate — always saves time and money. Using pharmacogenomics as a foundation for making the right care decisions has the same financial impact…for patients, the nation’s healthcare spend as a whole and, yes, even for individual physicians and practices.

Pharmacogenomics (PGx) — genetic testing to determine how a patient’s genetic background is likely to impact medication effectiveness and safety — continues to gain popularity to optimize drug delivery in today’s value-based care environment. While some medical practitioners are still watching as the science rapidly evolves, many studies are already showing its value…not only in positively impacting patients’ clinical and satisfaction outcomes but in financial benefits as well.

For patients

Patient benefits are pretty obvious. The “therapeutic odyssey” of trial-and-error prescribing to hit upon a medication that’s effective and safe for a particular patient can take many months. It also can significantly increase the cost of multiple prescriptions filled and the trips to your practice for continued visits. Of course, that’s in addition to lost days of work, the potentially fatal impact of adverse drug events (ADEs) and lower quality of life for the patient and his or her family.

In addition, there’s little to no cost to the patient for the simple PGx test — or for personalized PGx analysis and follow-up medication consulting by a clinical pharmacist — since Medicare and many other plans now cover such services, sometimes with no co-pay or deductible.

For payors and the nation

Prescription drugs comprise almost a quarter of the nation’s health premium costs, followed by physician services, office and clinic visits and hospital stays (in that order). If pharmacogenomic testing as part of a precision medicine initiative can lower the costs of the pharmacy therapeutic odyssey and the after-effects of ADEs, $30 billion can be saved in the U.S. each year. Hopefully, those savings will be passed back to patients/taxpayers in reduced premium costs, expanded coverage and funding for new medical innovations.

For providers

By leveraging the increasing power of PGx — empowering RxLive’s carefully selected clinical pharmacists in one-on-one private telehealth consultations with your patients — the benefits to your bottom line can include:

  • Increase your Medicare reimbursement by accounting for half to three-quarters of your clinical practice improvement activities (CPIA) score and up to 10% of your aggregate MIPS score. Remember: in this second year of MIPS reporting, cost now accounts for 10% of your total MIPS score, impacting your opportunities for Medicare reimbursement bonuses for 2020.
  • Increase your reputation as a cutting-edge practice versus local competitors
  • Decrease cost of implementing pharmacy and medication adherence-related programs required for various quality reporting programs

Are we there yet?

A study published in 2017 sums it up best: pharmacogenetic-guided treatment has the potential to personalize medical care and reduce cost versus standard treatment. It found that if genetic testing were broadly in use, at least 75% of economic evaluations would support PGx-guided treatment.

We think that number is closer to 100%, as each patient is truly unique. But as the study concluded, we agree that PGx is both a cost-effective and cost-saving strategy — one we think deserves more “press” in the expanding world of value-based care. That way, it can be more broadly understood and embraced by medical practitioners as it continues to evolve. At RxLive, we’re proud to play a role in making that happen.

You may also want to check out the following:

How Pharmacists and Pharmacogenomics Can Shorten Your Medication Prescribing Odyssey and Improve Your Patients Health
Should You Incorporate a Clinical Pharmacist into Your Practice?           

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Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.