Research indicates as many as 30 percent ofindividuals who are prescribed garden-variety drugs for chronicconditions are either taking the wrong drug, or the wrong dose ofthe right drug. (Image: Shutterstock)

In 2009, a scholarly article published in the Journal ofClinical Medical Research predicted: "Pharmacogenomics eventually can lead to anoverall decrease in the cost of health care because of decreasesin: (1) the number of adverse drug reactions; (2) the number offailed drug trials; (3) the time it takes to get a drug approved;(4) the length of time patients are on medication; (5) the numberof 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 fromAmrita Vishwavidyapeetham University in India, has come to pass.Precision medicine has become its own category, and gene testing has exploded. Now, that explosionis rocking employee benefits as well as the health care field ingeneral. Companies like Color Genomics, Pro-GeneX, andGeneYouIn–founded to explore the potential health care market forgenetic testing–are now marketing their genetic matching anddisease forecasting services to the lucrative employer-sponsoredplan market.

Other services have spun out of major health care players. MayoClinic launched OneOME, which co-developed with Mayo the RightMedgenetic test. And Intermountain Health, a major Utah provider,operates "Precision Genomics RxMatch" designed to match patientswith the proper drug and dosage.

The genetic lottery

Employers who offer health insurance to employees are attractedby the numbers: In the case of drug matching (AKA medicationresponse), research indicates as many as 30 percent of individualswho are prescribed garden-variety drugs for chronic conditions areeither taking the wrong drug, or the wrong dose of the right drug.In either case, for large employers, the cost of prescribing thewrong drug can be in the millions in paying for drugs that don'twork, and the related cost of lost productivity, sick days, andpresenteeism by people who are not benefiting from theirmisprescribed medication.

The payoff from the results of genetic testing for hereditaryconditions is longer term. But for large employers, havingemployees who are knowledgeable and taking control of their healthwill result in a more productive workforce down the line.

Jefferson Health, a major Pennsylvania health system with 30,000employees, added Color Genomics' gene testing to its benefitspackage a year ago. Color's testing service provides plan memberswith screening for 30 genes for cancer and heart disease, and 14genes for medications. Testing was free for employees, who coulddecline the test if they so desired.

GeneYouIn, a Canadian genomics firm, offers a drug matchingservice called Pillcheck. Already, it has a growing employer clientbase, which includes General Electric Co. It's promise tocustomers: "Pillcheck provides a genetics-based medication responsetest that predicts how effectively medications work for anindividual. We help benefit plans, advisors, and insurers lowerhealth plan costs while helping plan members feel better,faster."

Veronika Litinski, GeneYouIn's CEO, explains that Pillcheck "isa solution to something that's an ongoing challenge for most healthbenefit plans: rising costs and ensuring plan members see value intheir benefits. When plan members are prescribed medications,whether it's for pain after a minor surgery or a daily pill tocontrol a chronic condition, physicians typically take aone-size-fits-all approach. For many people, this creates amismatch between medications and how they're processed by the body.Employers end up paying for this in a number of ways, fromincreased sick days, disability claims to extra cost forineffective prescriptions. Pillcheck helps people and payers toavoid prescriptions that don't work and the time it takes tocorrect them."

Cracking the (market) code

GeneYouIn currently accesses employers directly throughinsurers. "We haven't yet cracked distribution through brokers,"Litinski says. "The plan sponsors understand the value of Pillcheckto avoid prescriptions that don't work. They see the value reallywell. But most organizations don't have huge benefits departmentsto evaluate Pillcheck properly. We are still working on educatingthe market and making plans aware of our services."

But as more plan sponsors get results from Pillcheck, the wordis beginning to spread. In one recent engagement with a Canadiangovernment employer with 850 employees, Pillcheck testing revealedthat 70 percent of those taking prescription medicationseither had been prescribed the wrong drug or the wrong dosage ofthe right drug.

"Cost savings to plan sponsors accrue in two ways," she says."People on right medications are healthier and don't see doctors sooften. And there is a small but meaningful reduction in drug costof about 5 percent due to the elimination of redundantmedication."

Pro-GeneX is more focused on preventing adverse–and oftenfatal–drug interactions. Its testing service can predict whether apatient, or plan member, can safely ingest a newly prescribedmedication. In its marketing materials, it says: "The cost of anadverse drug reaction is a heavy price to pay. We believe infinding the right drug, and the right dose the first time. in theeffects of rising prescription drug costs." The company claims tobe in use in "more than 200 facilities nationwide," providing"clinical support to maximize employee and patient safety whileminimizing costs."

Too soon?

As with any health care innovation, genetic testing is still aninfant in the benefits design world. Insurers, including Aetna,have begun to pay for the services. But it remains a new conceptfor traditional brokers, and many medical professionals resistendorsing it. They say more research data is needed to support theclaims of the gene-testers. Meantime, pharmacogenomics representsyet another layer of care for already overworked primary carephysicians.

But as genetics revelations steadily move the medicalpractitioners to more individualized care, the doctors andpharmacists will have to go along. Meantime, more employers aredemanding access to genetic tools to improve employee health andreduce their insurance spend.

Privacy issues are often cited as a barrier to plan memberparticipation. But the testing companies and the medical professionare crafting safeguards for those who agree to the testing. And thebenefits now available often outweigh privacy concerns,particularly with younger people who are used to having theirpersonal information shared.

What's the potential for add-on genetic testing services forplan members? Zayna Khahat, PhD, a Canadian health care strategist,says the medical movement toward individualized treatment offersendless 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 differenthealth indicators, the plan members and sponsors will be able tobetter tailor different products or services that the plan ispaying for," she says.

The quintet of authors of the 2009 Journal of Clinical MedicalResearch could not been more on the mark with their crystal-ballgazing. The services they saw in the future are now all incentivesfor large employers to call in the DNA testers. And more optionsare on the way.

Read more: 

• Precision medicine: worth theexpense?
• Why you should know what 'pharmacogenetics'is
• The next hot voluntary benefit: Genetictesting?