In 2009, a scholarly article published in the Journal of Clinical Medical Research predicted: “Pharmacogenomics eventually can lead to an overall decrease in the cost of health care because of decreases in: (1) the number of adverse drug reactions; (2) the number of failed drug trials; (3) the time it takes to get a drug approved; (4) the length of time patients are on medication; (5) the number of medications patients must take to find an effective therapy; (6) the effects of a disease on the body (through early detection).
A decade later, this prediction, made by five authors from Amrita Vishwavidyapeetham University in India, has come to pass. Precision medicine has become its own category, and gene testing has exploded. Now, that explosion is rocking employee benefits as well as the health care field in general. Companies like Color Genomics, Pro-GeneX, and GeneYouIn–founded to explore the potential health care market for genetic testing–are now marketing their genetic matching and disease forecasting services to the lucrative employer-sponsored plan market.
Other services have spun out of major health care players. Mayo Clinic launched OneOME, which co-developed with Mayo the RightMed genetic test. And Intermountain Health, a major Utah provider, operates “Precision Genomics RxMatch” designed to match patients with the proper drug and dosage.
The genetic lottery
Employers who offer health insurance to employees are attracted by the numbers: In the case of drug matching (AKA medication response), research indicates as many as 30 percent of individuals who are prescribed garden-variety drugs for chronic conditions are either taking the wrong drug, or the wrong dose of the right drug. In either case, for large employers, the cost of prescribing the wrong drug can be in the millions in paying for drugs that don’t work, and the related cost of lost productivity, sick days, and presenteeism by people who are not benefiting from their misprescribed medication.
The payoff from the results of genetic testing for hereditary conditions is longer term. But for large employers, having employees who are knowledgeable and taking control of their health will result in a more productive workforce down the line.
Jefferson Health, a major Pennsylvania health system with 30,000 employees, added Color Genomics’ gene testing to its benefits package a year ago. Color’s testing service provides plan members with screening for 30 genes for cancer and heart disease, and 14 genes for medications. Testing was free for employees, who could decline the test if they so desired.
GeneYouIn, a Canadian genomics firm, offers a drug matching service called Pillcheck. Already, it has a growing employer client base, which includes General Electric Co. It’s promise to customers: “Pillcheck provides a genetics-based medication response test that predicts how effectively medications work for an individual. We help benefit plans, advisors, and insurers lower health plan costs while helping plan members feel better, faster.”
Veronika Litinski, GeneYouIn’s CEO, explains that Pillcheck “is a solution to something that’s an ongoing challenge for most health benefit plans: rising costs and ensuring plan members see value in their benefits. When plan members are prescribed medications, whether it’s for pain after a minor surgery or a daily pill to control a chronic condition, physicians typically take a one-size-fits-all approach. For many people, this creates a mismatch between medications and how they’re processed by the body. Employers end up paying for this in a number of ways, from increased sick days, disability claims to extra cost for ineffective prescriptions. Pillcheck helps people and payers to avoid prescriptions that don’t work and the time it takes to correct them.”
Cracking the (market) code
GeneYouIn currently accesses employers directly through insurers. “We haven’t yet cracked distribution through brokers,” Litinski says. “The plan sponsors understand the value of Pillcheck to avoid prescriptions that don’t work. They see the value really well. But most organizations don’t have huge benefits departments to evaluate Pillcheck properly. We are still working on educating the market and making plans aware of our services.”
But as more plan sponsors get results from Pillcheck, the word is beginning to spread. In one recent engagement with a Canadian government employer with 850 employees, Pillcheck testing revealed that 70 percent of those taking prescription medications either had been prescribed the wrong drug or the wrong dosage of the right drug.
“Cost savings to plan sponsors accrue in two ways,” she says. “People on right medications are healthier and don’t see doctors so often. And there is a small but meaningful reduction in drug cost of about 5 percent due to the elimination of redundant medication.”
Pro-GeneX is more focused on preventing adverse–and often fatal–drug interactions. Its testing service can predict whether a patient, or plan member, can safely ingest a newly prescribed medication. In its marketing materials, it says: “The cost of an adverse drug reaction is a heavy price to pay. We believe in finding the right drug, and the right dose the first time. in the effects of rising prescription drug costs.” The company claims to be in use in “more than 200 facilities nationwide,” providing “clinical support to maximize employee and patient safety while minimizing costs.”
As with any health care innovation, genetic testing is still an infant in the benefits design world. Insurers, including Aetna, have begun to pay for the services. But it remains a new concept for traditional brokers, and many medical professionals resist endorsing it. They say more research data is needed to support the claims of the gene-testers. Meantime, pharmacogenomics represents yet another layer of care for already overworked primary care physicians.
But as genetics revelations steadily move the medical practitioners to more individualized care, the doctors and pharmacists will have to go along. Meantime, more employers are demanding access to genetic tools to improve employee health and reduce their insurance spend.
Privacy issues are often cited as a barrier to plan member participation. But the testing companies and the medical profession are crafting safeguards for those who agree to the testing. And the benefits now available often outweigh privacy concerns, particularly with younger people who are used to having their personal information shared.
What’s the potential for add-on genetic testing services for plan members? Zayna Khahat, PhD, a Canadian health care strategist, says the medical movement toward individualized treatment offers endless possibilities for benefits plan applications.
“Once you do a genetic test once, you have the data for life — so as the science gets better around genes linked to different health indicators, the plan members and sponsors will be able to better tailor different products or services that the plan is paying for,” she says.
The quintet of authors of the 2009 Journal of Clinical Medical Research could not been more on the mark with their crystal-ball gazing. The services they saw in the future are now all incentives for large employers to call in the DNA testers. And more options are on the way.