The Case for Pharmacogenomic Testing for All PACE Participants

Since 2013, CareKinesis has been providing PACE client organizations with optional pharmacogenomic (PGx) testing to support participants’ medication safety for those on certain pro-drug medications or when a long list of ‘allergies’ to medications was noted. However, in June 2015, a lawsuit was filed by the state of Hawaii against the two large drug companies who marketed clopidogrel (Plavix), which is an antiplatelet agent frequently initiated with the placement of coronary artery stents. On February 15, 2021, the court ordered the drug companies to pay more than $834 million to the state for misleading practices for failing to warn a subset of patients of health risks from Plavix.1

In light of these lawsuits, and several pending in other states, we are taking the opportunity to consider personalizing medication regimens for all PACE participants prospectively. Why?

First, we know that individuals of certain ancestries have variant genes that may not fully activate various medications. In the case of clopidogrel, this applies especially to those of Asian, African American, and Hispanic descent, and the gene CYP2C19, which activates clopidogrel. The only way to discover an individual’s gene status is through PGx testing.

We go beyond the drug/gene pair issue to ascertain if other externalities may render even “functional” CYP2C19 genotypes ineffective. These include determining if concomitant medications are present that have a stronger CYP2C19 affinity than clopidogrel, whereby this “competitive inhibition” converts a normal metabolizer to a poor metabolizer. Also noting if individuals taking clopidogrel have a chronic low-level inflammatory disease (e.g., type two diabetes), which also down regulates CYP2C19 (and a few other genes).

Second, in a recent study conducted by the TRHCPPRDI, 200 PGx clinical pharmacists’ consultations found that 73.6% of PACE participants were on at least one medication that they do not have the genes to fully metabolize, and/or had multiple copies of a gene that required dose reductions or alternative medications, and/or were compromised by phenoconversion. The study calculated a savings of over $233,000 in avoided medical costs or an annual $1,983 per participant. Up to 86% of pharmacist recommendations were accepted.

Third, utilizing PGx elevates personalized approaches to precision pharmacotherapy, and encourages inclusion in gathering PGx information on individuals of diverse genetic ancestries. PGx test results allow CareKinesis pharmacists and PACE clinicians to avoid trial-and-error prescribing, and pharmacist recommendations are guided by the latest PGx evidence, not just deduction and assumption. PGx testing and ongoing application is also best-practice protection against litigation.

Finally, CareKinesis is the only PACE pharmacy with the expertise, experience, and technology in place to monitor drug-gene pairs and simultaneous, multi-drug phenoconversion, also known as competitive inhibition. Our pharmacists are board certified in geriatrics, MedWise™ Advisor Certified, and have a deep understanding of drug metabolism, pharmacogenomics, pharmacokinetics, and pharmacodynamic. The apply the MedWiseproprietary risk stratification tools to keep PACE participants safe and healthy.

Administering a PGx test just once provides years of benefits for participants. PGx results are embedded within the MedWise risk mitigation tools in EireneRx™, enabling safer, precision medication decision-making with every change in a participant’s medication regimen.

Now is the time to consider PGx in your Part D Bid! In the upcoming weeks, your client liaison will reach out to see if you would be interested in having your entire population tested for use of their PGx data prospectively, to begin the future practice of precision pharmacotherapy in 2022. This charge will be considered a companion Rx and part of the Part D administrative fee.

Please contact your client liaison to learn more. For questions about PGx testing, please contact CareKinesis at 888-9-PharmD (888-974-2763), option 1 or info@carekinesis.com.