Pharmacogenetic testing:
A revolutionary tool in medicine and benefits management
Posted by Medavie Blue Cross on December 12, 2023
Pharmacogenetic testing:
A revolutionary tool in medicine and benefits management
Posted by Medavie Blue Cross on December 12, 2023
Imagine a plan benefit that helps pinpoint the drugs that will be most effective in treating members for their conditions? Think about the cost savings for plan sponsors from trial-and-error prescribing, not to mention lost productivity.
Coverage for pharmacogenetic testing makes it possible. This revolutionary tool in medicine and benefit management allows members to unlock their genetic code to receive the right medication at the right dosage to control plan costs and optimize health outcomes.
How does pharmacogenetic testing work?
Pharmacogenetics studies how well or poorly our bodies process or metabolize certain drug medication treatments. That’s because we all respond differently to drugs due to variations in our DNA. Genes can be the reason some drugs cause mild to severe side effects, like nausea, weight gain, even abnormal heart rhythms, or no adverse reactions at all.
Extracting the saliva from a single cheek swab, pharmacogenetic testing (PGx) looks for changes or variants in our genes to match drugs to our unique genome or genetic profile. The predictive insights provided by PGx help treating physicians prescribe the drugs their patients will respond to best, as well as the ideal dosages, based on their genetic makeup, with the least likelihood of side effects.
How does Medavie Blue Cross cover pharmacogenetic testing?
Since May 2021, the Pharmacogenetic Testing Benefit has been part of our standard offering for new business as an extended health benefit under Diagnostic tests. Existing groups can add this coverage upon request or at renewal.
As of Q4 2023, we offer the Pharmacogenetic Testing Benefit to all fully insured businesses. We first introduced this service in 2019 to complement the case management tools we use for disability claim management. This has given plan members and their treating physicians access to tools to help with an effective return to health and work.
How does Medavie Blue Cross cover pharmacogenetic testing?
Since May 2021, the Pharmacogenetic Testing Benefit has been part of our standard offering for new business as an extended health benefit under Diagnostic tests. Existing groups can add this coverage upon request or at renewal.
As of Q4 2023, we offer the Pharmacogenetic Testing Benefit to all fully insured businesses. We first introduced this service in 2019 to complement the case management tools we use for disability claim management. This has given plan members and their treating physicians access to tools to help with an effective return to health and work.
What are the advantages of testing?
This form of precision, personalized medicine has broad implications and benefits for all health care stakeholders.
Members can feel better, faster and return to work sooner, confident in their treatment, saving time, worry and expense for all concerned.
That’s in part because pharmacogenetics helps members access precision treatments for conditions that are significant drivers of benefit plan spending either because of high incidence rates or high drug costs, such as mental health conditions, certain cancers, cardiovascular disease and autoimmune disorders.
In addition to helping to contain plan costs, optimal treatment for any condition can decrease workplace absenteeism and increase productivity, as well as prevent or reduce the duration of short-term and long-term disability claims. Test results can also support members with medication adherence, which is critical to ensuring drugs are used to maximum effect and benefit dollars are well spent.
What are the advantages of testing?
This form of precision, personalized medicine has broad implications and benefits for all health care stakeholders.
Members can feel better, faster and return to work sooner, confident in their treatment, saving time, worry and expense for all concerned.
That’s in part because pharmacogenetics helps members access precision treatments for conditions that are significant drivers of benefit plan spending either because of high incidence rates or high drug costs, such as mental health conditions, certain cancers, cardiovascular disease and autoimmune disorders.
In addition to helping to contain plan costs, optimal treatment for any condition can decrease workplace absenteeism and increase productivity, as well as prevent or reduce the duration of short-term and long-term disability claims. Test results can also support members with medication adherence, which is critical to ensuring drugs are used to maximum effect and benefit dollars are well spent.
How can members access testing services?
Members can access pharmacogenetic testing through our digital health platform, Connected Care, at preferred pricing from Pillcheck or directly from approved providers such as Pillcheck, BiogeniQ and Personalized Prescribing Inc. All meet the highest standards in security and confidentiality and can test for approximately 70 per cent of the most commonly prescribed drugs.
It is important to note that these tests look at gene markers to gain predictive insights into a patient’s tolerance to certain medications. However, other factors, beyond genes, can also affect their response to drugs, such as age, weight and diet.
How much does the testing cost?
Our partnership with Pillcheck through Connected Care provides preferred member pricing. Members can directly self-order the test or claim it with a prescription using their Pharmacogenetic Testing Benefit, under their Extended Health plan.
Members without a prescription may reimburse this expense through a Health Spending Account or Personal Wellness Account or claim it as a medical expense for income tax purposes.
Isn’t genetic testing prohibited?
PGx is not to be confused with “recreational genetics” that can help us trace our ancestral roots – think AncestryDNA – or genetic testing that reads our DNA to determine our potential risk for disease.
PGxs analyze only the specific genes involved in drug metabolism to determine the risk of toxicity and side effects. They do not assess a patient’s inherited predisposition to disease, which, by law, under Bill S-201, prohibits discrimination based on genetic characteristics. PGx does not impact members’ insurance.
Isn’t genetic testing prohibited?
PGx is not to be confused with “recreational genetics” that can help us trace our ancestral roots – think AncestryDNA – or genetic testing that reads our DNA to determine our potential risk for disease.
PGxs analyze only the specific genes involved in drug metabolism to determine the risk of toxicity and side effects. They do not assess a patient’s inherited predisposition to disease, which, by law, under Bill S-201, prohibits discrimination based on genetic characteristics. PGx does not impact members’ insurance.
Who receives testing results?
Plan member participation in pharmacogenetic testing is voluntary and confidential. MBC-approved service providers are compliant with all industry regulations that protect data privacy.
Once the testing results are processed, they are forwarded directly to the plan members, who can share them with their health care practitioner, at their discretion, to prescribe gene-guided drug therapies and dosages.
To learn more about having the Pharmacogenetic Testing Benefit as part of your plan, speak to your Medavie Blue Cross representative.
Medavie Blue Cross is a premier all-in-one carrier that provides health, dental, travel, life and disability benefits and administers federal and provincial government-sponsored health programs. Together with Medavie Health Services, we are part of Medavie, a health solutions partner committed to improving the wellbeing of Canadians. We are in the...