Tapping each person’s unique genetic information to guide the treatment of illness has long been a goal in pharmacology. In recent years, steady progress has been made in pharmacogenetics or PGx. Using genetic tests, PGx identifies links between human genes and medicines. This person-specific data helps enable more accurate prescribing of medicines.
The genetic variation inherent to every human can greatly influence how the body responds to a medication. This can include everything from how fast the body activates a medication to potentially serious allergic reactions. Importantly, these pharmacogenetic variations are not rare. A study estimated that 99% of people possess at least 1 clinically important pharmacogenetic variant.1 Nevertheless, this vital information has remained largely siloed from the prescribing process.
Using PGx tests, a prescriber can better gauge how a patient’s unique genetic variations may influence their response to a given drug. In addition to identifying patients at risk for therapy failure or adverse reactions, PGx can guide drug selection and dosing schedules.
Despite the promise of PGx, an enterprise-scale, systemic approach to its use is vital to unlocking its full potential. That’s why Optum Rx has launched Optum Rx Guided Pharmacogenomics. This industry-first program helps members know that the medications they are taking are most likely to work for them based on their genetics.
Moving beyond trial-and-error prescribing
The sheer variety of treatment options means physicians must weigh a variety of factors when deciding what to prescribe. This is especially true for medical conditions in areas such as behavioral health, cardiology and pain management.
Historically, physicians will adjust a drug regimen over time after observing a drug’s efficacy and side effects. As a result of this iterative approach, some members may go on medication journeys that can last months and even years.
In contrast, PGx-guided therapy accounts for drug-gene interactions with clinical evidence supporting lack of effect or harm before prescribing the medication. In other words, PGx does not replace the prescriber’s decision-making process. Instead, it can act as a powerful tool to support their decision-making.
While raw PGx data is essential, the Optum Rx Guided Pharmacogenomics program goes further. It helps prescribers interpret and apply those results to real-world clinical situations.
The program begins by using advanced analytics to identify plan members most likely to benefit from pharmacogenomics testing. Once a member agrees to join the program, a simple, one-time cheek swab test is mailed to them. After the swab is returned and analyzed, results are shared with the member. The member can then opt to take part in an educational consult with our team of PGx-trained and certified pharmacists. Our pharmacist next engages directly with the member’s physician, translating the test results into actionable medication adjustments.
Importantly, Optum Rx will continue to monitor the member’s pharmacogenomic profile for new drug-gene interactions as their treatment history evolves. If a new medication conflicts with the member’s genetics and an actionable intervention exists, we will engage with their provider to inform of the possible benefits of an alternate medication or dose.
The collaborative, consultative design of Optum Rx Guided Pharmacogenomics is intended to:
- Arm physicians with the knowledge they need to help prescribe the right drug at the right time at the right dose.
- Improve member health and quality of life by assuring the medications they take are best suited for them based on their genetics.
- Improve clinical outcomes and lower overall health care costs through the optimization of medication regimes.
- Reduce the chance for adverse drug reactions, a leading cause of costly emergency room visits and hospital stays.
- Eliminate the waste associated with trial-and-error prescribing.
A differentiated approach
The Optum Rx Guided Pharmacogenomics program exists within the broader context of the clinical programs offered by Optum Rx. For example, the program is designed to work synergistically with existing utilization management strategies for enhanced medication safety and effectiveness. The program was also designed with cost and billing clarity in mind and is charged on a per-tested-member basis.
To further maximize value for plan sponsors, our program only focuses on the most meaningful drug-gene interactions and those members most likely to benefit from it. To qualify for the Optum Rx Guided Pharmacogenomics program, a drug must be filled as an outpatient prescription, taken chronically and be clinically actionable. Of the more than approximately 400 medications with drug-gene associations, we have identified 66 of the most important to launch the program.2
This targeted approach stands in marked contrast to some competitor offerings. Some of these programs focus on all drug-gene annotations from the FDA and engage prescribers on all findings, whether they are actionable or not.
The benefits of Optum Rx Guided Pharmacogenomics are not just theoretical. Over the past few years, Optum Rx has conducted extensive proof of concept pilots, and a clinical study to generate real-world data on the program. These efforts have enabled us to fine-tune Optum Rx Guided Pharmacogenomics to deliver demonstrable value to a broad array of plan sponsors.
Preliminary data indicates that about 13–17% of plan members will be eligible for the program.3 The uptake among providers is also encouraging. Of those surveyed, 90% indicated they would make the adjustment suggested by the program or they likely would but needed to discuss it with their patient.4
What begins with a simple cheek swab can help inform a lifetime of improved medication decisions for the individual. With 20% of members obtaining clinically actionable results upon testing, the program also unlocks the potential for lower overall health care costs at the population level.5
The arrival of Optum Rx Guided Pharmacogenomics shows that the once elusive promise of PGx is now becoming a broadly available reality. Talk to your Optum Rx partner to learn more and hear about other ways we are redefining pharmacy care services through innovation.