Advancing The Profession of Pharmacy

Genetically Precise Medicines: The Future is Now

by | Dec 5, 2015 | Big Picture Ideas, MTM Entrepreneurship

HowThere is an exciting new industry arising the the field of healthcare.  It known as pharmacogenomic testing.  This means science can now map your genome, then use the information to help your doctor and pharmacist choose the medications that will work best for you.

You may have also heard it referred to as “personalized medicine”.  Genetic lab testing is no longer an ideal for the future.  It is here, responsive and dynamic.  It is being made easy to use by intelligent software with medication tracking capabilities.

 

What is it?

Personalized DNA profiles are being made available to your health care providers, thanks to the labs and software being produced by the New Jersey company Emgenex.
The testing process is very simple.  Once your personal doctor or pharmacist is setup to perform the test, they will be able to swab your cheek for DNA.  The swab is sent to the lab and a report of the genomic sequence is made within 3-5 days.  Your doctor or pharmacist will receive a detailed report of your genetic profile that they will be able to use to put you on the most effective medications.  Gone are the days of “trial and error” prescribing.

This new genetic testing software allows for responsive and dynamic management of your medications and it doesn’t cost a fortune.  Considering the human genome project took 13 years and cost nearly US $3 billion for a composite genome, while a whole genome can now be sequenced in approximately a day for under US $1000.

Great news for Medicare members as well.  Medicare is breaking new ground by paying for its member to receive these tests with no out of pocket expense to the member.  Genetic testing allows your healthcare providers to use your genetics to an advantage and design a personalized medication regimen based on your genome.

 

How can it help patients?

For clarity, allow me to provide a very common example of how a simple genetic test could save your life.

Patient A:  A 58 year old male has his first heart attack.  In the hospital he gets a stent placed, and his cardiologist puts him on clopidogrel (Plavix).  He goes home thinking the medication will work to prevent another heart attack.

However, if Patient A is a poor metabolizer of an enzyme called cytochrome (CYP) 2C19, he may not respond fully to the platelet inhibiting effects of clopidogrel and will be at higher risk for another heart attack or stroke.  The medication clopidogrel is an inactive chemical structure.  It requires activation by the liver enzyme CYP2C19.  Clopidogrel is what is know as a prodrug.

A simple genetic test is all that is needed to determine if the patient’s liver can make enough of the  enzyme needed to activate clopidogrel to its full anti-clotting potential.  If the doctor or pharmacist is able to check the new prescription against the patient’s DNA profile, they would be able to use an alternate medication such as prasugrel (Effient) or ticagrelor (Brilinta).

So what are one’s chances of being a poor metabolizer of enzyme 2C19?

A gene variant (*2) is present in 25% of whites, 30% of blacks, and 40%-50% of Asians.

If that isn’t convincing enough, the genes responsible for this activation of clopidogrel also play a role in the clearing of certain drugs from the body.  A person who is a poor metabolizer of 2C19 will be at higher risk of being over-medicated on certain antidepressant drugs.

Genetic testing isn’t only helpful when started on new medication therapy.  It can also help oncologists decide treatment options in certain cancers such as breast, colon, and non-small cell lung cancer.

 

How can Pharmacists use this information?

Pharmacists can help ease the transition from “defensive medicine” to proactive medicine by helping physicians become early adopters of this new pharmacogenomics testing technology.

Point-of-care DNA testing can be easily added to a pharmacy’s spectrum of clinical service offerings. When pharmacists can combine medication therapy management with the power of personalized genetic testing, they can provide excellent patient care.

Knowing your genetic profile can help your doctors avoid using medications that may be ineffective or even supra-therapeutic and harmful.  The genetic test is one that can keep you and your loved ones from hospitalizations due to adverse drug reactions and ineffective medications.  The future is now, join the precision medicine movement and ask your doctor or pharmacist about genetic testing today!

If you want more information on how you can add DNA testing to your pharmacy or as part of your independent consulting services, contact Dr. Thielemier at blairthielemier@btpharmacyconsulting.com to find out how you can begin offering pharmacogenomics testing services!

About the Author

Blair Thielemier, PharmD, is an MTM consultant pharmacist specializing in pharmacy billing models. She consults on and produces e-learning programs for state and national organizations, pharmacy wholesalers, payers, technology start-ups. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at PharmapreneurAcademy.com. She speaks internationally about trends in leveraging pharmacists to improve value-based care.

 

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