Canadian HR Reporter

F E AT U R E S BENEFITS F E AT U R E S BENEFITS F E AT U R E S By Michael Prouse C ompanies are always searching for drug plan strategies to keep the workforce healthy, while simulta- neously reducing rising costs. Unfortu- nately, many benefi ts that promise this fall short because of persistent absentee- ism, presenteeism, disability and medica- tion waste. Employees are absent from work on aver- age 9.3 days per year, according to 2011 numbers from Statistics Canada, costing the Canadian economy roughly $16 billion annually, according to a 2013 report from the Conference Board of Canada. Studies have also shown presenteeism can be more costly than absenteeism, while disability can add up to a signifi cant percentage of payroll. One of the driving forces behind these health-related factors is poor prescription drug compatibility. Medications often do not work on patients, while adverse drug reactions can lead to hospitalizations and sometimes death. e result is a prolonged trial-and-error period in selecting the best drug that works. Pharmacogenetics Employees are all unique, and so are the ways they respond to medications. Some people break down certain medications effi ciently, while others do it slowly. ese diff erences are predominantly governed by genetics. Pharmacogenetics studies how genes infl uence an individual's ability to metabo- lize specifi c drugs. A genetic test can now predict the right drug, at the right dose, for the right person — drastically reducing the trial-and-error process. A simple, non- invasive cheek swab can identify a patient's drug compatibility for more than 900 drugs. Genetic testing for therapeutic response is diff erent than genetic testing for disease risk, which reveals a certain chance of de- veloping a disease. is information is not a diagnosis and could lead to employees be- ing afraid of discrimination and even apathy about negative test results, which might en- courage unhealthy behaviours. In contrast, with genetic testing for therapeutic response, as is the case with pharmacogenetic testing, disease risk is not reported. Further, this information can be acted upon immediately and cannot be used to discriminate against the patient — the doctor is given this information as a tool to allow her to tailor the therapy. Employee benefi ts For plan sponsors, the cost of pharmaco- genetic tests is off set by savings realized through the avoidance of hospitalizations, reduction of medication waste, greater safe- ty and effi cacy in the use of medications, and avoidance of costs due to employee absenteeism, presenteeism and disability. A Medco/Mayo joint study in 2010 re- ported a 30 per cent drop in hospitalization rates for patients who received a pharmaco- genetic test before taking warfarin, a com- monly prescribed anticoagulant medica- tion. Another study published in the March 2013 edition of Translational Psychiatry found this test could help reduce general medical visits by 67 per cent and help re- duce absenteeism and disability claims by three- and four-fold respectively. e most eff ective way to purchase a pharmacogenetic test is to take advantage of either a volume purchasing arrange- ment or a fi xed subscription plan, instead of paying the normal retail price (which can be upwards of $1,000). is can be achieved through buying groups or ben- efi t plan add-ons, similar to an employee assistance program (EAP). e ideal situation would see the plan sponsor paying a fi xed monthly fee to allow anyone to requisition a test when needed. Once pharmacogenetic tests have been implemented as a benefi t, plan members can start requisitioning their tests when they become eligible. Eligibility is granted if the plan member is prescribed a medica- tion covered under the pharmacogenetic plan. After the test is requisitioned, she will re- ceive a swab package. After she completes a cheek swab, it is shipped to the genetic lab at no additional cost. e laboratory analyzes the genetics and provides an easy-to-read drug-gene com- patibility report directly to the person's doc- tor, giving the physician a tool to elevate his prescribing power. Individuals should have the ability to requisition a test even if they are not on an eligible medication. As a plan sponsor, it is important to accommodate these in- dividuals to ensure the best possible health outcomes. Proactive plan members should be able to requisition the test at a discounted rate through their employer's group plan, or a co-pay method, to help protect them. Patients' private information should be kept confi dential from their peers, em- ployers and insurers. To accomplish this, private genetic information is only shared with their physician, based on explicit pa- tient consent. Plan sponsors should be able to access anonymous, aggregate usage reports to track if this benefi t is truly bringing posi- tive outcomes to their company. Looking ahead Biologics: Currently, no pharmacogenetic test exists to predict a patient's response to biologic drugs, which are typically the most costly drugs in any plan. For example, the biologics used to treat rheumatoid arthritis — Enbrel, Remicade and Humira — work in about 60 per cent of patients, costing employers a signifi cant amount of money. However, a pharmacogenetic test is in the pipeline of being developed to help off set this drug plan problem. Step therapy: Step therapy is the medi- cal practice that aims to fi rst provide a pa- tient with the most cost-eff ective and safe therapy, and then progresses to more costly or risky therapies, if necessary. Step therapy can lead to prolonged trial-and-error peri- ods because the treatment has been pre- scribed in a one-size-fi ts-all method. Pharmacogenetics evaluates the individ- ual to predict the best treatment possible for that particular patient, eliminating the need for step therapy and long trial-and- error periods. Prior authorization: Pharmacogenet- ics can have a great impact on the prior authorization process. For example, the Ontario Trillium Drug Benefi t program requires a genetic test (G511D) for prior au- thorization to allow patients to be covered for ivacaftor, a cystic fi brosis drug costing $300,000 annually. In the future, employers and insurers will start to use pharmacogenetic testing as a prior authorization tool to manage the sustainability of drug plans. Implementing pharmacogenetics into a benefi t plan is a cost-eff ective way to help a company's drug plan run as effi ciently as possible — no employer drug plan should be without it. Michael Prouse is director of operations at Personalized Prescribing in Toronto. He can be reached at mike@personalizedprescribing.com or, for more information, visit www.personal- izedprescribing.com. Can pharmacogenetics provide much-needed answers? 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