Biomarkers: Top challenges and opportunities in managed care

Biomarkers, if used appropriately, could ensure patients are diagnosed earlier, that they are matched to the appropriate treatment sooner, and that they have better outcomes at reduced costs. But despite the potential and expanding capabilities, barriers to full-fledged use remain.   

During their October 5 session, “Biomarkers and Treatment Decision-Making: Focus on Rheumatoid Arthritis,” at the Academy of Managed Care Pharmacy (AMCP) Nexus 2016, in National Harbor, Maryland, three presenters explored the opportunities and challenges biomarkers present, and the role they could play in the future of healthcare delivery.

Brixner

Diana Brixner, RPh, PhD, FAMCP, professor in the department of pharmacotherapy at the University of Utah, who co-presented with John Watkins, PharmD, MPH, BCPS, pharmacy manager, formulary development, at Premera Blue Cross, and Grace C. Wright, MD, PhD, clinical associate professor of medicine at New York University Langone Medical Center, said biomarkers go hand-in-hand with personalized medicine.

It’s about personalizing medication choices and treatment decisions to make sure patients get the right drug at the right time at the right cost, she said.

For example, a physician or payer could use biomarkers or other diagnostic tests to determine how well a particular segment will respond to therapy, and whether that segment will have minimal adverse events.

“From a managed care perspective, we don’t want to invest money in a drug that we know, based on genetic information, is not going to work,” said Brixner. “Segmenting the population is very important.”

Many biomarker tests are currently available, and they are becoming more sophisticated and increasingly used as an additional tool used to determine disease progression and potential course of treatment, she said.

Some examples include:

· Magnetic resonance imaging

· Serum chemistries

· Autoantibodies

· Bone density measurement

· Pulmonary function tests

· Genetic markers

Brixner said biomarkers can be split into three categories:

· Diagnostic: Distinguish health vs. disease.

· Prognostic: Predict natural history of disease in absence of further intervention.

· Predictive: Predict an outcome following an intervention (e.g., response or lack of response to a drug).

Some examples include prognostic testing for chemotherapy response (for example, Oncotype DX/adjuvant chemotherapy); and testing for hereditary markers of risk (for example, BRCA1/2 testing/more frequent monitoring and/or surgical options).

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