PBMs, Not Physicians, Stepping Up for Genomics

Check out Docs Falling Behind In Race To Help Patients With Genetics, a physician's thought-provoking perspective on the beneficial role of Pharmacy Benefit Managers (PBMs) in accelerating pharmacogenomics—using a patient’s genetic information to optimize drug therapy.

While I can't speak as a medical professional, I'm not surprised to hear this viewpoint from a leading physician. PBMs have powerful incentives to invest in personalized medicine tools that will improve clinical outcomes and manage utilization for their clients. As I see it, successful implementation of these services will be one way for PBMs to maintain spreads within the PBM economic model.

You can complement this article with Genomics: What Lies Within for a good discussion of the DNA sequencing market from The Economist.

Cardiologist Eric Topol, director of Scripps Translational Science Institute in La Jolla, is an unabashed fan of PBMs' efforts to advance pharmacogenomics. He writes:

“While physicians and the life science industry have done little to advance the use of testing for drug-gene interactions, now the pharmacy benefit managers (PBMs) Medco and CVS/Caremark, which collectively administer the employer prescription plans for nearly 100 million Americans, are stepping up. They are introducing wide-scale genotyping for certain drugs, like Plavix or Tamoxifen, and many anti-cancer medications…It has caught the medical community by surprise, but may be just the thing that is needed to bring the marked progress in genomics forward for patients.”

You can read more in Dr. Topol’s original commentary "Pharmacy Benefit Managers, Pharmacies, and Pharmacogenomic Testing: Prescription for Progress?" in Science Translational Medicine. The scientific article is behind a pay-wall, but this newspaper editorial makes the same basic points.

The Economist provides the following useful chart of the cost for DNA sequencing in Genomics: What Lies Within.

As they note with their trademark British wit:

"Most [people] have paid a few hundred dollars for tests on only a few genes, to see if they are likely to contract a specific disease. They might learn more if they had their entire genome sequenced. A decade ago this would have cost a billion dollars—a bit pricey for most consumers. But the cost is falling so fast that whole-genome sequencing could one day be affordable to anyone who can spit into a cup."

Yes, a billion dollars is just "a bit pricey." LOL!