PBMI: Real-world Impact of Pharmacogenomics

Pharmacogenomics and precision prescribing is emerging as a new approach for medication management, Jeffrey A. Shaman, Ph.D., chief science officer at Coriell Life Sciences, said at the Pharmacy Benefit Management Institute (PBMI) annual meeting in Orlando.

Jeffrey A. Shaman, Ph.D.

“Drugs work or don’t work in some people, and they also work differently in some people,” he said. “There can be toxicities, or side effects. This can lead to high costs and poor outcomes.”

In fact, 1 million emergency room visits a year are a result of adverse drug reactions and annually about 2 million adverse drug reactions are seen, Shaman said. Additionally, 50% of patients are on a prescription drug that fails to be effective.

Pharmacogenomics uses DNA testing to predict how a patient will likely react to or be affected by specific medications. This, combined with medication management systems, can help identify patients who may be ultra-rapid, normal, intermediate, or poor metabolizers of prescription drugs, Shaman said. Then physicians and pharmacists can work together to determine the appropriate medications and dosing of patient’s medications.

In one case study, published earlier this year in the Journal of Personalized Medicine, researchers from Coriell Life Sciences partnered with the Teachers’ Retirement System of the State of Kentucky (TRS) to improve medication management and reduce medication-related adverse events. TRS provides retirement income and health insurance to 140,000 teachers and education professionals. Shaman was one of the authors of this paper.

TRS member enrollment in the program was optional, which Shaman said gave them a control group that was almost closely matched in terms of age, gender, medications, and other factors. A DNA collection kit was sent to participants for in-saliva collection. The samples were sent to and analyzed by Quantigen Biosciences. The assays chosen were based on their relationship to medication use outcomes. Coriell’s clinical decision support system was used to evaluate the patients’ medication regimens. This analysis allowed them to note medications that could be added, removed, modified, or monitored.

They found that pharmacogenomics with medication management was able to save TRS $7,000 per patient in direct medical charges. This, Shaman said, resulted in $37 million in saving over 5,288 enrollees at 32 months. The program resulted in a 14.9% reduction in patient claims, a 6.8% reduction in emergency room visit claims, and 1.9% in outpatient claims. They also saw a positive shift in healthcare resource utilization away from acute care services and toward more sustainable and cost-effective primary care options.

The pharmacogenomics and the medication management program at TRS continues and they expect to see a continued decrease in healthcare costs. The paper’s authors suggest that saving may even accelerate because of an aging population of members who many have been prescribed any medications at the start of the program.

In a second case study that Shaman mentioned during the PBMI meeting was of a large manufacturing company who implemented a similar program. This company saw a decrease of $77 per member, per month in the intervention group with cumulative cost savings of almost $1 million over 12 months. Healthcare resource utilization resulted in an estimated 495 annual working days saved per 1,000 employees.