How to Get a Pharmacogenetic Test in CanadaAntonietta Cerroni, Ph.D.
You may have heard the term “Precision Medicine” and wondered what it really means and how it can be applied to everyday life. There is one application to healthcare that empowers you to take control over your own health and well-being by allowing you to take a closer look at your prescription medications and how your body processes them. It is called “pharmacogenetics”, and it is giving healthcare providers evidence-based decision-making tools that help to tailor medications more precisely to a patient’s specific genetic makeup. So, what exactly does it do and how do you get a Pharmacogenetic Test in Canada?
What does it do for you?
A Pharmacogenetic (PGx) Test is a predictive tool – it reveals how a patient would respond to a medication before it is prescribed, helping doctors choose the most effective drug therapy quickly and more efficiently, resulting in safer, more effective treatments with fewer side effects and better health outcomes for their patients. It is a personalized approach that finds the right medication at the right dose, based on a person’s unique genetic profile for specific drug metabolizing enzymes. People who experience adverse side effects or a reduced response to their medication can benefit from PGx testing to find the optimal treatment for their condition. This type of genetic test for medication effectiveness has been available for a number of years.
PGx Tests are not identical. How do you choose the right test for your needs? There are a number of factors to consider:
1. Treatment areas that are covered by the PGx Test
Some PGx Tests are focused on just one treatment area, for example, only medications for mental health conditions. However, these tests have proprietary interpretation of various biomarkers, providing sometimes discordant recommendations on drug selection and dosing. Other PGx Tests, such as Pillcheck™, cover many of the most commonly prescribed medications in a variety of therapeutic areas, such as: cardiovascular disease; gastrointestinal conditions; mental health (antidepressants and antipsychotics); pain management; rheumatology and oncology. Since your DNA does not change, this broader scope ensures that your test report will be a useful reference for your current and future prescription needs. Pillcheck also adheres to standardized recommendations developed by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the drug labeling information from FDA, Health Canada and other regulatory bodies.
2. Which CYP450 genes and other markers are tested
There are a number of important genes that control the metabolism and transport of medications in the body (i.e., how well the body processes and clears them). A comprehensive PGx Test should cover these markers: CYP2D6 (including copy number variants or CNVs); CYP2C9; CYP2C19; DPYD; TPMT; VKORC1; SLCO1B1; UGT1A1.
A truly comprehensive test will also include rare ethnic variants – forms of genes that tend to occur at high frequency within certain ethnic groups – an important factor if you happen to be a member of one of these groups. Inadequate test sensitivity increases probability of delivering false negative results – i.e. person with significantly altered drug metabolism is given a report with “green check”.
3. What happens after you get your PGx Test results?
You have received your pharmacogenetic test results. Now what? You should not change your medications based on pharmacogenetic test until your results are reviewed by your physician or expert pharmacist. Most companies do not offer support services beyond providing your test results. Pillcheck™ offers a support service that includes facilitating communication between you and your prescribing physician through a specially trained pharmacist. Pillcheck Pharmacist Opinion Letter can help your physician to apply PGx insight to your treatment.
What happens to your DNA and your health date? Ancestry DNA testing providers subsidize the cost of genetic testing by selling customer’s genetic and health data to pharma companies. Medical diagnostic tests are by far more expensive because of stricter regulatory and privacy regulations, and disclose whether they are sharing individuals’ data with external providers. Pillcheck destroys your DNA and does not share customer data with others.
4. Cost & Reimbursement
PGx Tests qualify for reimbursement through your Health Spending Account (HSA) if the service includes a review by a physician or pharmacist. Many insurance plans cover pharmacogenetic testing under extended healthcare benefits. You may be required to submit a physician requisition or prescription in order to be eligible for reimbursement. Check whether your plan includes coverage for laboratory diagnostic testing.
How do you get a Pharmacogenetic (PGx) Test in Canada? There are several ways:
- You can order it directly from a company that offers a PGx service by purchasing it online (Direct-to-Consumer approach)
- You can ask a healthcare practitioner to order it for you; specialists in certain healthcare clinics or hospitals can place an order for a PGx Test
- Some community pharmacies can order a PGx Test on your behalf as part of their comprehensive service, which may include facilitating a prescription change with your doctor
Thank you for reading! If you would like to learn more, please send us your comments and questions.
User considerations in assessing pharmacogenomic tests and their clinical support tools https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133969/
Bousman CA and Dunlop. Genotype, phenotype, and medication recommendation agreement among commercial pharmacogenetic-based decision support tools. Pharmacogenomics J. 2018 Sep;18(5):613-622.
Bousman, C.A. et al., Navigating the Labyrinth of Pharmacogenetic Testing: A Guide to Test Selection. Clin Pharmacol Ther. 2019 Apr 20. doi: 10.1002/cpt.1432. [Epub ahead of print]
Share on Twitter.