Group health plans are an increasingly popular option for employers looking to provide viable health coverage for their employees. Naturally, not all plans are created equal. However, what distinguishes a successful group plan from a costly and ultimately unworkable financial burden depends on the patient experience, health outcomes, and structural details that can have a dramatic impact on the cost and ROI of the plan.
New treatments, new frontiers, and advances in cutting-edge medical science are providing new options that can change the way plans and protocols are assessed, with significant implications for patients, employers and providers. One particularly exciting new frontier showing the potential to lower costs and improve outcomes is pharmacogenomics—utilizing gene mapping to better prescribe drugs.
The pharmacogenomic frontier
Pharmacogenomics uses gene mapping and sophisticated testing to identify individual health needs and prescribe medications more likely to be effective for the individual patient.
While prescription protocols have traditionally been based on broad-brush statistical models, also known as the drug most likely to be safest and most effective for the largest percentage of patients, the degree to which individual biology varies means there will always be some patients who respond better than others to various medications. There’s a reason why those dire side-effects warnings are presented so prominently in pharmaceutical advertising and medication documentation.
This is where pharmacogenomics comes into play. By evaluating the gene structure of the individual, doctors can determine an individually customized course of treatment. This practice has the potential to reduce unnecessary or ineffective prescriptions, lower incidence of side effects, and deliver medication and treatment solutions that work well the first time.
The long-term potential of this intriguing and potentially game-changing new field is exciting. The ability to use personal genetic information to not just predict drug response, but to provide insight into drug and dosage selection to optimize treatment, could potentially lead to treatment that isn’t just safe and more effective, but subsequently more cost-effective. One prominent study showed patients receiving pharmacogenomic testing saved well over $1,000 in annual medication costs relative to patients receiving standard care.
Challenges, solutions, and conclusion
Pharmacogenomics did not just suddenly burst into the scene. This emerging science has been, quite literally, decades in the making, slowly moving from theoretical benefits, to testing, to applied science. Like all new technologies and treatments, there is a high barrier of proof that has to be overcome, and an understandable reluctance to fully accept new principles, practices and protocols until they have been comprehensively proven to be safe, effective and impactful.
Until recently, the relatively modest amount of evidence demonstrating the effectiveness of testing and the clinical validity of pharmacogenomic treatment has slowed widespread adoption. Fortunately, evidence is mounting pharmacogenomics can contribute to beneficial clinical outcomes and, consequently, positive financial impacts by decreasing the burden of unnecessary costs for healthcare networks and insurance providers. One potentially important trend to watch is the ongoing shift from reactive testing of single genes, to proactive testing of multiple genes, as this could further shift the cost-benefit equation in a favorable direction.
The CDC itself recognizes the growing role pharmacogenomic testing could play, pointing out “Improved understanding of how pharmacogenomics can protect your health and improve your treatment will be increasingly important” and encouraging patients to “Talk to your healthcare provider about what pharmacogenomics might mean for your health.”
While there are understandable concerns about patient privacy and personal medical data, the Genetic Information Nondiscrimination Act (GINA) has been in place for more than a decade, and it specifically prohibits denial of coverage due to an individual’s genetic profile.
Continued study and evidence gathering to support the value and validity of pharmacogenomic testing is essential. However, the evidence seems to increasingly point to an undeniable conclusion: pharmacogenomics leads to healthier patients and healthier bottom-lines for stakeholders. And while this technology is still maturing, pharmacogenomic services are already available through a number of providers. Employers would be wise to ask about what options are available to them. Those who are able to take advantage of pharmacogenomic testing options to enhance their group plan can reasonably expect to see potentially reduced plan costs and improved health outcomes. The result would be fewer risks, bigger rewards, and improved productivity and performance from a happier and healthier workforce.
Mark Manquen is founder and president of Manquen Vance, a strategic health plan advisor helping public and private employers.