In 510 B.C.E., Pythagoras unwittingly made one of the first contributions to pharmacogenetics when he observed that ingesting fava beans could cause lethal toxicity in select individuals. Today, this increasingly important field of scientific study offers an opportunity to rein in wasteful prescription spending.
Benefits professionals are well-served to learn as much as they can about this fast-growing science and its role in prescribing. Complex and high-cost specialty drugs dominate the drug pipeline in the United States, and are expected to account for 50% of drug spend by 2020. Many such drugs require testing for certain genetic and metabolic markers.
Thanks to the completion of the Human Genome Project and related research, scientists have gained greater insight into how the body responds to various substances. This research supports the use pharmacogenetics to ensure safe and effective prescribing in an era of medicine where 55% of Americans take prescription drugs.
A Prescription for Wasteful Spending
America spends roughly $200 billion annually on unnecessary and inappropriate prescription drug utilization, and up to $1 trillion as a whole on wasteful healthcare expenses. With medical errors and adverse drug reactions considered the third and fourth leading causes of death in the nation respectively, the importance of smart prescribing cannot be ignored.
(Related: Consumers, Insurers and Genetic Information)
Today’s prescription drug marketplace has seen the approval of therapies that can cost hundreds of thousands of dollars for a single treatment. Meanwhile, research shows that many important classes of drugs, ranging from mental health to cancer treatments, are effective in only 25-60% of the patient population. Benefit professionals must seek creative solutions to ensure that their clients provide access to the right care. Pharmacogenetics can be one those solutions.
Wasteful prescription spending goes beyond the purchase of medications that a member does not truly need. It encompasses spending on medications that might actually harm the member, or that may have no therapeutic effect for the member despite being used as recommended. It also includes spending on complications, additional medications to reduce side effects, and disease progression that could have been avoided if the right medication had been prescribed at the right dose the first time.
Using Metabolic Fingerprints to Target Medication Therapy