An emerging resource for employee benefits plans
By Joseph Ricciuti
The community of human resource professionals is in general agreement that it makes good business sense to develop and implement programs that promote and support a healthy workplace. However, in spite of such strategies, there is a continued struggle to reduce healthcare costs and improve productivity in the workplace.
As the modern workplace evolves, employees are faced with unprecedented change. They must find ways to function against a backdrop of intensifying work demands, new job skill requirements and a changing economy that may impart additional stress and work strain. These consequences negatively impact the mental and physical health of employees and, in turn, the business performance of the organization.
The efforts of employers are often focused on employee assistance programs, community resource navigation tools and medical support programs. Unfortunately, they do not address the pharmacological side of a clinical treatment plan.
Now, with advancements in scientific discovery and new technology, Pharmacogenomics (PGx) has emerged as an exciting new resource with the potential to play an important role in improving employee health, supporting disability management and maintaining productivity at work. Simply defined, PGx is the study of how genes affect a person’s response to drugs. It combines pharmacology (action of drugs) and genomics (study of genes/genome) to tailor medications and doses to a person’s genetic make-up.
It provides physicians with insights to personalize a prescription treatment plan that was otherwise unattainable and based on a “one-drug-fits-all” mentality. For example, take the current method of prescribing in the field of mental health: It is not derived from any scientific tools that help predict who will and won’t benefit from a medication treatment plan. Instead, it is a “prescribe-it-and-see” approach that has become the accepted norm along with adjustments and a lot of guessing.
Unfortunately, a by-product of this trial-and-error process is the patient’s loss of hope and confidence in taking their medication, which is an additional complication in pursuing sustainable treatment. It’s a big healthcare issue because the perpetuation of treatment results in greater loss of work performance, absenteeism and disability. This translates into higher medical costs and employee turnover. The challenge is to determine the correct medication and dose that would be effective and cause little or no adverse reaction to employees and, ultimately, this will have a positive impact on business performance.
However, now we can take full advantage of PGx and, in the process, be more precise and personalized in understanding and developing both the pharmacological and clinical aspects of treatment plans. This fills an important gap by taking the guesswork out of the prescribing equation. It is now possible to determine, with a high level of confidence, the appropriate drug, at the correct dose, with minimum side effects.
This is exciting news for organizations and their insurance and disability management providers. They recognize the value PGx has on reducing healthcare costs, shortening the disability duration period and improving treatment quality for employees. They are now embracing the science and, according to a recent HRPA-P3 survey, making it available as part of the employee benefits plan. Likewise, disability case managers are starting to recommend the test as part of their return to work protocols.
Studies of PGx testing show that employees can better pinpoint their prescription drug compatibility and increase adherence:
Personalized Prescribing Inc., a cutting-edge pharmacogenomic testing company that focuses on precision medicine, recently completed an annual report on a pharmacogenomic test for an organization that manages disability plans. It found that 86 per cent of the employees referred by the disability managers had at least one defective gene.
A CAMH study on patients with a primary diagnosis of depression or anxiety disorder showed that they received maximum benefit from the treatment plan, recovered more quickly and avoided potentially harmful side effects.
A 2013 study published in Translational Psychiatry determined that a pharmacogenetic test for employees on at least one of 26 commonly used antidepressant and antipsychotic medications could reduce absent days three-fold and disability claims
four-fold.
A study published by Nature Publishing Group in 2013 determined that a pharmacogenetic test could predict which patients with obsessive-compulsive disorder would have more failed medication trials, with greater rates of adverse
drug reactions.
A 2012 Mayo Clinic research study reported that giving a pharmacogenetic test to patients with depression could significantly reduce depressive symptoms.
Another study projected that a six-gene PGx test could save, on average, $5,188 per year in healthcare costs for individual psychiatric patients who were not content with their
current medications.
There are two main challenges when considering a PGx test for employees. First, people may be apprehensive about taking a genetic test since they fear it may reveal their predisposition to a disease. Second, many may worry about confidentiality and privacy issues in terms of identity theft or discrimination.
Communication and education are the best ways to alleviate this apprehension. PGx testing is different than genetic testing for disease risk. A PGx test cannot reveal any disease predisposition and is not designed to do so. The objective is to test compatibility of the drug by determining its efficacy and toxicity. The genes tested are only meant to look at the way the patient processes a medication, which means the genes tested are involved in drug response, not diagnosis of the disease state.
In addition, a PGx test is available only on a voluntary consent basis and with appropriate safeguards in place to codify results and ensure confidentiality of information. According to Bill S201 (The Genetic Anti-Discrimination Act passed in April 2017), employers cannot require employees to undergo a genetic test or disclose the results of a genetic test as a condition of providing goods or services or entering into a contract. This ensures that Canadians are protected against discrimination.
A PGx service can mitigate employee concerns by offering, as a first step, a medication review with a pharmacist. There is often a trusting relationship with pharmacists and this plays an important role. The pharmacist may conclude that a PGx test can enhance the employee’s drug compatibility and the employee would then have comfort in knowing that a trusted professional helped them make an informed decision.
Technology has advanced dramatically, making PGx testing an easy and convenient task. The test can be done with a simple non-invasive cheek swab or spit kit which is mailed to a state-of-the-art genetic laboratory to have the results processed. Once analyzed, a drug-compatibility report is sent to the patient’s doctor so medications can be personalized. The test can be ordered online or over the phone, and the test result is available within five to seven business days.
There has never been a better time to take advantage of the benefits of PGx, and human resource departments can lead the way by integrating PGx into their employee benefits plans.
Together, science and technology can now predict what medications will be successful. It’s a helpful resource that can’t be ignored and will serve to improve the health and wellbeing of employees, and the productivity of the organization.
Joseph Ricciuti is co-founder and Board Chair of MHIB (Mental Health in a Box) Global Inc.