PBM-Offered Genomics Testing Could Reshape Prescribing of Medications

As healthcare costs continue to rise, innovative strategies such as genomics testing are reshaping how employers, insurers and pharmacy benefit managers (PBMs) approach patient care. Pharmacogenomics — how a person’s DNA affects their response to medications — could become a standard of care in the near future, according to Adrienne Williams LaBorwit, the newly appointed CEO of True Rx Health Strategists.

Adrienne Williams LaBorwit

Genomics testing stands out as both a clinical innovation and a cost-containment strategy. For LaBorwit, the goal is clear: “Healthcare has lost its personal touch. We’re bringing it back by focusing on the individual — one test, one prescription, one life at a time.”

True Rx launched its pharmacogenomics program, True Genomics, in 2022. Patients who have been prescribed medications for mental health, pain or heart health receive a cheek swab test that identifies how their body metabolizes certain drugs. The results help clinicians determine which medications are most effective clinically for each individual. Since the True Rx program launched, clients have chosen True Genomics to support nearly 40,000 patients. This is nearly 90% growth from fiscal year 2024 to the second quarter of 2025.

“Mental health is one area where this is a game changer,” LaBorwit said. “Psychiatrists often have to guess which medication might work. Our testing removes much of that guesswork, helping patients get the right treatment faster.”

Capital Rx launched Rx Helix late in 2022, and the first client came on board on July 1, 2023. Currently, program eligibility is limited to patients identified as taking a variety of different medications with high levels of evidence supporting the potential for a drug-gene interaction, in addition to pharmacogenomics being mentioned on the FDA label. Capital Rx officials also say behavioral health is the largest area for genomics.

Sara Izadi, Pharm.D.

“Pharmacogenomics is transforming healthcare - and its value is driving more precise, informed prescribing, particularly in complex areas like behavioral health and inflammatory diseases where traditional ‘trial-and-error’ approaches to therapy waste time and money, ultimately impacting patient well-being. That’s why we launched Rx Helix: to give plan sponsors a streamlined, cost-effective way to integrate PGx into their benefit programs,” said Sara Izadi, Pharm.D., chief clinical officer at Capital Rx.

Capital Rx is able to identify members who would benefit from genomics testing in real-time through Judi, the PBM’s enterprise health platform. Patients are identified based on the refill of several maintenance medications known to have potential drug-gene interactions.

Both True Rx and Capital Rx work with Aranscia (AccessDx and YouScript) on the testing and clinical informatics side, which provides the AccessDx PGx profile. This test looks for drug-gene interactions and structural variations, enabling the identification of both common and rare ethno-specific variations. The test is a cheek swab that patients can do at home; they receive a prepaid envelope for returning the test. About 30 genes are analyzed to determine medication matches in multiple medication categories. Common medications analyzed include antidepressants, statins, blood pressure medicines, ADHD/ADD medications and oral chemotherapy.

The programs of both PBMs include pharmacist consultation for the patient to understand what the results mean and recommendations to the patient’s providers when appropriate. Capital Rx officials have said that one patient during the pharmacist consultation indicated that she has had a history of low blood pressure and heart rate attributable in part to the member’s inability to normally process her beta-blocker medication. The pharmacist counseled the member on the importance of self-monitoring and managing blood pressure at home, which was something the member did not know how to do.

Misaligned prescriptions not only cost employers and insurers but also compromise patient well-being. In one example LaBorwit shared, a patient had been taking four medications for a mental condition, but the four drugs together were not effective for her condition. “When we sent them the test kit, we actually found the one medication that this person’s body could process and was effective for them,” she said. “We took that patient from four medications down to one.”

In another example, a patient had high blood pressure, and the medication was not working for her. “When she got her genomics testing back, we found that an uncommon medication that was 30 years old would be effective for her.”

LaBorwit said physicians like the genomic testing because it takes the guesswork out of prescribing. “The information allows them to treat patients better. The doctors are supportive of the testing. They don’t have time to keep up with different medications, and they don’t know everybody’s personalized DNA,” she said.

The testing can add some initial costs to employers’ programs, but a recent study of the program demonstrated that employers’ total cost is on average $2,400 less for patients who receive pharmacogenomics testing through True Genomics. “Employers understand that when you improve someone’s health, you will reduce costs. Or you’re reducing costs in extra PTO or sick leave or productivity,” LaBorwit said.

LaBorwit said they see True Rx less as a PBM and more as health strategists, helping their clients to improve health while controlling costs and taking care of the patient. “We want to create forward-thinking, personalized solutions because healthcare is personal,” LaBorwit said in an interview. “We’re investing in clinical patient health outcome programs.”