RIMS Report

Breakthrough Testing Still in Need of Traction

Pharmacogentic testing has the potential to save money and even lives, but a great deal of skepticism remains.
By: | May 5, 2015

If a workers’ compensation payer agreed to fund genetics testing to ensure an injured worker would actually benefit from prescribed medications, the simple cheek swab and lab test would cost about $700.

But according to three speakers who promoted genetics testing during the Risk and Insurance Management Society Inc.’s recent 2015 conference, these still-misunderstood tests could save countless more dollars and improve employee health.

They said the tests would map an individual’s genetic uniqueness to help doctors understand how well a patient would metabolize specific medications. That would further help doctors prescribe drugs most probable to be safe and effective for each patient.

Pharmacogentic testing (PGX) would eliminate the trial-and-error process doctors and patients currently practice when trying to find the right medication for patients who frequently react differently to specific drugs, the speakers said.

The current process delays effective therapeutic treatment and drives up costs when a prescribed drug doesn’t have the intended impact. Trial and error also endangers lives when costly and escalating drug regimens that don’t work eventually include prescriptions like opioids, which may harm certain patients or trigger addiction, according to these genetics testing proponents.

They see PGX becoming a “standard of care” and part of an overall march toward “personalized medicine.”

Only 50 percnt of patients currently respond positively to the medications they are prescribed.

Yet with few people who have actually participated in PGX and insurers still not paying for it, skepticism remains.

Fewer than a dozen people attended the RIMS conference session on PGX, including myself and another writer.

Was lack of interest due to 9 a.m. start time in New Orleans, a late-night party town? Or was it the employee and risk manager skepticism the speakers know must be overcome before the PGX takes off, as they expressed confidence it will?

“Even the physicians aren’t comfortable with it yet,” said Geralyn Datz, one of the speakers and director of Southern Behavioral Medicine Associates. A recent poll of thousands of doctors revealed that only 28 percent of them had “some comfort level” with the testing, Datz said.

Yet the speakers made some convincing arguments for PGX’s future.

The U.S. Food and Drug Administration currently recommends genetic testing for patients prescribed 160 different medications and 15 of those drugs are used in workers’ comp in “a major way,” said Kimberly George, a senior VP at Sedgwick Claims Management Services Inc.

Only 50 percent of patients currently respond positively to the medications they are prescribed, Datz said.  She thinks consumers wanting more effective health care will eventually demand the testing.

Sonny Roshan, chairman and CEO of Aeon Clinical Laboratories, said the federal Centers for Medicare & Medicaid Services is a proponent of the testing, another reason the speakers expect its eventual adoption.

Roshan is also working with a large health insurer wanting to learn more about PGX.

The signs point to a potential that doctors will eventually consult PGX results before writing prescriptions for more workers’ comp patients. But it will also take more than just doctor and patient willingness to use the tests.

Claims adjusters, for example, will have learn of their benefits and claims payers will eventually demand to see return on investment documentation.

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

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