Pharmacogenomics and the Future of Pharmacy

Pharmacists have long been touted as the medication experts, but to maintain that title they will need to expand their knowledge of pharmacogenomics, and they need to do so quickly.

“We need them to take leadership and ownership in this space now rather than later because it’s harder to try to get something back than it is to start showing interest and potential early on,” says Amina Abubakar, PharmD, AAHIVP, owner of Rx Clinic Pharmacy in Charlotte, NC.

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Each year, the field of pharmacogenomics, which is also known as pharmacogenetics and explores how genetics affect patient response to medications, evolves. FDA data show that more than 260 therapeutic agents now have information on how genes affect them in their drug labeling. That number continues to grow as new research emerges. Information obtained from pharmacogenomics can reveal how medication dosing might need to be altered for a patient, or how certain medications might lead to an adverse reaction.

“The science advances in the field are just making it more critical that pharmacists have a really strong understanding of how to blend this into their training,” says Kathleen Jaeger, senior vice president of Pharmacy Care and Patient Advocacy for the NACDS.

While the emerging field requires pharmacists to add to their knowledge base, it also presents an important opportunity to enhance their role as a member of the care team.

“In my opinion, they should be the people that own pharmacogenetics,” says Daniel Dowd, PharmD, vice president of medical affairs at Genomind, a personalized medicine platform that offers a genetic test to guide treatment for a range of psychiatric conditions. “It’s a relatively new field, and who better than pharmacists to optimize drug therapy?”

Community pharmacies, including chain and independents, have already begun offering point-of-care pharmacogenomic services, including taking buccal swabs and sending them to a lab for genetic testing, counseling patients on the results, and working with physicians to develop optimal care plans for individual patients.

Here’s more on how pharmacists are stepping into this field, and how their actions are benefiting patients-and their bottom line.

DNA and the Neighborhood Pharmacy

This spring, Albertsons announced a pilot program with Genomind to bring genetic testing and counseling to 21 of its Sav-On pharmacies in Boise, ID; five of its Jewel-Osco pharmacies in the Chicago area; and two Sav-On pharmacies at Acmes in the Philadelphia area.

The pharmacies will use the genetic test designed by Genomind to optimize treatment for patients who have had unsuccessful experiences with medication for depression, anxiety, obsessive-compulsive disorder, or other mental illnesses.

Genomind’s specialty in mental health dovetails with Albertsons’ focus on mental health in its company specialty care pharmacy.

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“We are already seeing some of these patients in our stores to administer long-acting injectables and so we are able to coordinate that in with this,” says Kimberly Hecht, PharmD, who works in patient care and specialty services/new service development for Albertsons.

According to Hecht, patients can either request the screening on their own, be referred by a physician, or receive a recommendation from a pharmacist.

Up next: Revenue perks

“It would be patients who maybe are newly diagnosed and they want to pay for the test before they try their first treatment so they don’t try and fail treatment,” Hecht says, adding that other good candidates for the test would be those who have already tried several treatments and haven’t been successful.

One of the goals of the pilot program is to gauge the interest patients and physicians have in the service, and assess whether pharmacists feel it’s an area where they can make a difference in improving medication use. “We’re hoping to see how this new tool helps us better serve patients and improves their outcomes more quickly as they face mental health challenges such as depression, anxiety and obsessive-compulsive disorder,” explains Hecht.

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Hecht says they also plan to study whether the consultations pharmacists have with patients regarding the test results are more effective in person or over the phone. Expansion of this service will be determined based on patient and physician satisfaction and the ability of Albertsons Companies pharmacists to make medication interventions to improve patient outcomes. “Because of our expertise and experience in mental health with Specialty Care, we hope to prove this new service is a natural fit for our pharmacy staff helping patients who are dealing with mental health issues.”

Brian Hille, BSPharm, RPh, vice president of Patient, Specialty and Wellness Services for Albertsons, says the company will make the decision whether to expand the services to more stores after assessing what kind of uptake the program receives.

Albertsons may be just beginning their foray into personalized medicine, but Fruth Pharmacy, a regional chain serving West Virginia, Ohio, and Kentucky, has been offering genetic testing at all its 30 retail stores for more than a year. The pharmacy offers the pharmacogenetic program known as Rxight developed by MD Labs. The test uses DNA taken from a cheek swab to evaluate how an individual’s genetic profile may influence treatment decisions. According to the company’s website, the test covers more than 200 prescription and OTC medications.

Lynne Fruth, president of Fruth Pharmacy, says since they’ve begun offering the service they’ve seen a lot of interest in assessing mental health medications and screening children to find the best treatment option whether it’s for ADHD, depression, or other conditions.

The pharmacies have had good feedback from parents of school children who had struggled with finding the appropriate selection and dosing of ADD medications, Fruth says. Testing can help patients determine which specific medications to treat ADD or ADHD may be more effective in a given patient and which may not work as effectively due to an individual’s metabolism, she notes. 

Pharmacogenomics can also be effective in selecting pain medications or deciding whether a patient should take clopidogrel, she adds.

The pharmacy has teamed with Marshall University in Huntington, WV, and MD Labs to address the opioid crisis and will be doing genetic testing on opioid-addicted pregnant mothers, new mothers, and babies to identify the appropriate dosages of buprenorphine for them. “We’re excited to be doing that,” Fruth says.

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After the results from the test are received, patients have a personal medication review with a pharmacist who walks them through the results and explains any implications from the findings.

Revenue Perks

The clinical benefits of using pharmacogenomics are vast, but adopting a pharmacogenomics program can yield significant business advantages for a pharmacy.

As an independent owner, Abubakar has been committed to developing what she calls a “journey beyond dispensing” at her pharmacy, but she found that services such as medication therapy management weren’t helping her generate revenue.

Offering genetic screening has allowed her to establish herself as an expert in personalized medicine, and boost her pharmacy’s revenue. The lab she partners with bills the pharmacies a flat fee of $200 for the testing. Abubakar’s pharmacy then charges $395 for the service and uses it to enhance their medication therapy management program. She says some pharmacies charge as much as $500 for the testing and counseling services.

Fruth reports that her pharmacies charge $400 for the service. Several insurance companies and Medicare part D plans will pay for the service when testing is done for cardiology or behavioral health reasons, otherwise patients may take on the cost themselves. She says those who have paid have reported that the results and its implications for medication therapy choices have been well worth the cost.

The additional revenue has been a bonus, but Abubakar says she’s most excited to be able to use a complex science to improve the lives of her patients.

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Fruth says offering the genetic testing services also helps pharmacists solidify their role as a patient’s regular pharmacist because it gives the pharmacist an opportunity to get to know the patient during the counseling session. Pharmacists are able to demonstrate their knowledge during these sessions and communicate an individualized understanding of the patient.

“It’s really just makes that pharmacist stand out as really a part of that care team. So to me, that’s where the real opportunity is for independents and smaller operators,” she says.

Making Pharmacists the Experts

There’s also advocacy work that still needs to be done on a national scale, to establish the pharmacist’s role in pharmacogenomics.

Abubakar has spoken at the White House and to the FDA about her work in pharmacogenomics and the role she believes pharmacists can play, but she says there’s still a lack of knowledge in Washington that pharmacists have the skill set and capabilities to be a leader in pharmacogenomics.

“Not everyone has the same information about pharmacists,” Abubakar says. “Many asked me, ‘Are you sure pharmacists can do that?’”