Article preview from "The Pink Sheet" December 2, 2008
Find out why Medco is managing pharmacogenomic testing services for 100 of its clients to optimize dosing for warfarin and tamoxifen, Chief Medical Officer Rob Epstein reported during the firm's analyst day conference Nov. 21.
Article preview from "The Pink Sheet" December 2, 2008
Medco Warfarin, Tamoxifen Genomic Testing Finding Traction Among Payers
Medco is managing pharmacogenomic testing services for 100 of its clients to optimize dosing for warfarin and tamoxifen, Chief Medical Officer Rob Epstein reported during the firm's analyst day conference Nov. 21.
The clients enrolled in the new clinical service are primarily employer groups covering more than 4 million members who are taking one of the two drugs, Epstein added. The testing service is positioned as a way to avoid unnecessary medical costs through more effective drug use.
The program is an outgrowth of Medco's ongoing research on the use of genomic testing for safer warfarin dosing and to predict better outcomes with tamoxifen 1.
The service involves Medco scanning the pharmacy claims database associated with a particular client to identify patients beginning either warfarin or tamoxifen therapy. The PBM's pharmacy staff then contacts that member and the prescribing physician to offer the test - a cheek swab assay.
"We're actively sending out test kits, getting back results and moving patient doses or therapies accordingly," Epstein said.
Paying For Tests
Clients pay for the laboratory test through Medco. Epstein explained the PBM is working toward using its scale to get enough of a discount on the test to offer the entire program - including identifying candidates for the test, outreach to physicians and patients and handling results - at the equivalent of the regular price of the test alone.
Test results go to the physician and to Medco. The PBM incorporates the findings into its patient profiles, so that dosing for other drugs that are metabolized through the same genetic pathway can also be improved, Epstein noted.
The pharmacy benefit manager began rolling out the genomic testing program in May. Medco decided to launch the program before completion of its research in response to strong interest among payers, according to Epstein.
A final analysis of the warfarin research, which is being conducted along with the Mayo Clinic, is expected next summer. The tamoxifen study is in the data analysis stage. Medco has partnered with LabCorp and Indiana University for that project.
Based on the interest in its program to date, Medco is planning to develop further personalized medicine programs in 2009 in the areas of oncology, virology and rheumatology, Epstein said.
Medco's efforts in advancing personalized medicine build on its Therapeutic Resource Center program, which uses pharmacist counseling to improve medication adherence and ultimately reduce unnecessary medical costs.
The firm supports six TRCs covering chronic-use medications in the following areas: rare and specialty diseases, oncology/immunology, diabetes, cardiovascular disease, pulmonary disease and neurology/psychiatry.
Closing Gaps In Adherence
During the analyst day, Medco TRC President Peter Juhn presented data indicating that on average 76 percent of gaps in medication adherence were "closed" in 90 days through TRC counseling. The analysis was based on results from six clients covering approximately 600,000 members.
Juhn recently joined Medco from Johnson & Johnson, where he was responsible for evidence-based medicine as VP of evidence and regulatory policy.
The firm also linked better adherence with lower total health costs. Using Medco's repository of integrated pharmacy and medical claims for 19 million members, the firm estimated that total cardiovascular health-related costs per person could be $300 to $700 lower annually with accompanying TRC services.
The medical claims used in the integrated database are provided by Medco's health plan clients, a company spokesperson explained.
The TRC program reflects Medco's intention to establish its "clinical superiority" at retail, CEO David Snow said. Chief Financial Officer Rich Rubino added that Medco's "return on investment" for the TRC program is reflected in its new sales and client retention.
- Cathy Kelly
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