How pharmacogenomics can prevent drug spend waste
More and more Canadians are taking prescription drugs as chronic disease and mental health problems become more widespread. But prescribing can be a challenge because each person’s unique metabolic profile—informed by their unique genetics—determines which drugs will work and which will not. Empire Life has been working with Pillcheck for three years to help plan members find the right pharmaceutical treatments sooner rather than later, so they can enjoy their lives and return to work without needless delay. For employers, the savings can add up: depending on the diagnosis, drug therapy guided by Pillcheck can save between $350 and $5000 per patient.
Pillcheck CEO Veronika Litinski was guest speaker at a recent Empire Life advisor webinar. We spoke with her afterward.
Empire Life: Does everyone have a genetic makeup that affects the way a drug will work in their bodies?
Veronika Litinski: Yes. Based on genes, nearly everyone is likely to have an atypical response to at least one drug. In simple terms, the very different diets our ancestors had—in the Mediterranean basin versus northern Europe or Asia—has led to differences in how individuals today metabolize drugs. Depending on which enzymes a person has or doesn’t have, their reaction to a drug can be faster or completely dormant.
For any medicine to work properly, it needs to be present in the bloodstream at a specific concentration and for a period of time. Pharmacogenetic science (or PGX for short) is about the interplay of the individual metabolic profile, which is informed by our genes, and various pharmaceutical formulations. Once your Pillcheck profile is done, any healthcare provider can use it to effectively adjust pharmaceutical treatments to fit better. In fact, healthcare providers are two times more efficient in identifying and correcting drug therapy problems with a Pillcheck report on hand. And Pillcheck PGX customers access their results 2.4 times per year—that’s once every five months after the initial delivery of their results. So this really is a benefit that keeps delivering value year after year.
Empire Life: Prescription medicine has come a long way in the past century. Today there are thousands of drugs approved for the Canadian market—and more people are taking prescription medicines. Why does having a pharmacogenomics test matter?
Veronika Litinski: It matters for three reasons, which I’ll get to in a minute, but first I’d like to underscore that drugs as we think of them today are relatively new. Herbal remedies have a long history around the world going back millennia, and ancient herbalists knew their patients deeply. But it’s less than 150 years ago that the first ready-dosaged, prepackaged, factory produced medicine appeared. The drug was antipyrine, which relieves pain and swelling caused by middle ear inflammation. The year was 1883. Aspirin was first marketed in 1899.
The drug landscape has changed massively in the intervening years. Not only in number—Statistics Canada reports that there are 16,059 drugs approved for human use in Canada today—but also in utility and power to address many health issues that used to be untreatable.
Innovative medicines are proven cost savers as they help patients live longer, more productive lives. But often, people have issues with their prescribed medications. The most common challenge is unwelcome side effects; sometimes medications are simply not effective for an individual. Unfortunately, despite pervasive variability in drug response, our routine practice treats everyone as an average person. Personalized medicine in the form of pharmacogenomics testing can help doctors to adjust for this inherent variability.
Three factors advisors and plan sponsors need to think about
Now to answer your question, there are three factors advisors and plan sponsors need to think about. The first is cost. When there’s a mismatch between people’s genetics and the drugs they are prescribed, money’s paid for medicine that’s wasted. Prescription drugs help millions of Canadians every day—but finding the right drug in the right dose can be costly, time-consuming, and dangerous. Taking a drug that your body cannot metabolize leads to problems two and three: human suffering is prolonged—needlessly—and if a person is on disability leave, they may remain off work longer than necessary, which can harm a customer’s business. What makes this even more challenging is that with every additional drug you take, the risk of side effects or medication not working increases.
From a numbers perspective, more and more Canadians are taking more and more drugs. As I noted in the webinar, Statistics Canada reports that:
- 55% of adults aged 18 to 79 used at least one prescription drug in the past month,
- 36% used two or more,
- 24% used three or more.
But awareness isn’t widespread. Benefits Canada published its 2022 Healthcare survey and, in line with past years, it reports that plan sponsors underestimate just how many employees are dealing with chronic conditions or chronic pain. In a way it’s understandable: you can’t tell just by looking at someone that they have diabetes or anxiety. In modern health care, appropriately used prescription drugs are an essential component to health and well-being.
When nearly a quarter of employees are taking three or more drugs, getting the right prescription in the right dose can make a big difference—for employees and employers.
Look at this graph assembled from the analysis performed by US Veterans Health Administration and usage of PGX drugs by the insured population in the Netherlands. As you can see, antiarrhythmic medicines and drugs that are routinely used to treat conditions like depression, anxiety, PTSD, chronic pain, and digestive issues don’t work for everyone. An "altered" drug response encompasses a lot of things; but generally speaking, it means a certain drug might not affect one person the way it does another. A person takes a drug and their body does not respond as intended—so they need to try something else.
Empire Life: If I take the Piilcheck test, what can I expect in terms of results?
Veronika Litinski: The typical outcomes include a recommendation to switch drugs, switch doses, increase monitoring, or discontinue the drug. In an independent study published by the Journal of American Pharmacists Association, patients filling prescriptions at two Toronto pharmacies were offered Pillcheck analysis if they had concerns about their medication. The study showed that 78% of prescriptions needed adjustments.
Pillcheck is automatically included in Empire Life disability benefits. The cost of testing can also be covered by a healthcare spending account or the Empire Life Incidental Health Expense.
For more information, please reach out to your Empire Life account team or group plan advisor.