PBMs jump into genetic testing

In Personalized prescription, the Boston Globe chronicles the efforts of the two leading pharmacy benefit managers, CVS Caremark and Medco, to introduce genetic testing into the prescribing process. CVS Caremark is pursuing its strategy through an investment in Generation Health (see my interview with Generation's founder Per Lofberg) and Medco has been pursuing its own program. (See my interview with Medco's vice president of personalized medicine research and development.)The article focuses on the use of genetic tests to reduce drug costs, e.g., by discouraging the use of drugs that don't work for a given patient and by suggesting lower-cost generics. That's certainly a logical place to start, but it's by no means clear that drug cost reduction will be the primary impact of such genetic tests. For example, a test may identify that a patient has a predisposition to a particular disease and trigger upfront spending on drugs or treatment to prevent or delay onset. A test could also show that a more expensive on-patent product is better for a given patient than a lower cost item.Genetic tests can also have worrisome and expensive consequences. Generation Health is aware of this and its value proposition includes helping employers and health plans figure out which genetic tests are best for specific members, what those tests should cost, and which tests should be avoided. The tests themselves can be pricey, and sometimes provide information that can't readily be acted upon, cause undue anxiety or trigger additional expensive, invasive and possibly dangerous testing.