Real-World Impact of a Pharmacogenomics-Enriched Comprehensive Medication Management Program

Abstract

The availability of clinical decision support systems (CDSS) and other methods for personalizing medicine now allows evaluation of their real-world impact on healthcare delivery. For example, addressing issues associated with polypharmacy in older patients using pharmacogenomics (PGx) and comprehensive medication management (CMM) is thought to hold great promise for meaningful improvements across the goals of the Quadruple Aim. However, few studies testing these tools at scale, using relevant system-wide metrics, and under real-world conditions, have been published to date. Here, we document a reduction of ~$7000 per patient in direct medical charges (a total of $37 million over 5288 enrollees compared to 22,357 non-enrolled) in Medicare Advantage patients (≥65 years) receiving benefits through a state retirement system over the first 32 months of a voluntary PGx-enriched CMM program. We also observe a positive shift in healthcare resource utilization (HRU) away from acute care services and toward more sustainable and cost-effective primary care options. Together with improvements in medication risk assessment, patient/provider communication via pharmacist-mediated medication action plans (MAP), and the sustained positive trends in HRU, we suggest these results validate the use of a CDSS to unify PGx and CMM to optimize care for this and similar patient populations.

Early Insights From a Pharmacogenomic-Enriched Comprehensive Medication Management Program Implementation in an Adult Employee Population

“…Adoption of the PGx + CMM program has been shown to produce positive economic and healthcare resource utilization changes for a retiree population 65 years old and older. 20 Altogether, the findings presented in this report suggest similar opportunities to improve healthcare outcomes and medication management in broad employee, adult populations, and even in those who may not be part of a unified health system. In the retiree population, greater than 76% of MAPs were identified as actionable, 20 similar to 85.8% observed in this employee population, supporting similar opportunities to address medication risks.…”

“…Adoption of the PGx + CMM program has been shown to produce positive economic and healthcare resource utilization changes for a retiree population 65 years old and older 20 . Altogether, the findings presented in this report suggest similar opportunities to improve healthcare outcomes and medication management in broad employee, adult populations, and even in those who may not be part of a unified health system.…”

Pharmacogenetic Testing in a 70-Year-Old Woman with Polypharmacy and Multiple Comorbidities: A Case Report

“…The probability of experiencing ADEs can be minimized through appropriate testing, like pharmacogenomic (PGx) testing and related therapeutic adjustments [ 9 , 10 ]. Pharmacists trained in PGx are well-positioned as members of interdisciplinary health-care teams to interpret PGx results, recommend actions to mitigate MRPs, and educate clinicians, especially to help guide statin and warfarin therapy [ 9 ].…”

“…The probability of experiencing ADEs can be minimized through appropriate testing, like pharmacogenomic (PGx) testing and related therapeutic adjustments [ 9 , 10 ]. Pharmacists trained in PGx are well-positioned as members of interdisciplinary health-care teams to interpret PGx results, recommend actions to mitigate MRPs, and educate clinicians, especially to help guide statin and warfarin therapy [ 9 ]. This case report demonstrates how preemptive PGx testing, while utilizing a clinical decision support system (CDSS), would have identified drug-gene and drug-drug interactions at the time of prescribing, resulting in reduced risk of ADEs [ 11 ].…”

Clinical Pharmacogenomic MT‐RNR1 Screening for Aminoglycoside‐Induced Ototoxicity and the Post‐Test Counseling Conundrum

“…Although reimbursement for reactive and pre-emptive pharmacogenomic testing is an evolving landscape, emerging evidence indicates that pre-emptive pharmacogenomic testing is cost-effective compared with usual care (in contrast to reactive testing), including significant reductions in healthcare cost utilization. 1,2 However, challenges with broadly implementing pre-emptive testing include a lack of a well-defined post-test result disclosure processes; defining the specific and synergistic roles of clinicians, pharmacists, and genetic counselors; compliance with the evolving regulatory agencies; and difficulties with effectively utilizing electronic healthcare record (EHR) systems to convey essential information at the point-of-care (POC).…”