How to get a pharmacogenetic test in Canada
Updated June 29, 2023
Pharmacogenetic tests are available online direct to consumers and may even be covered by your health insurance or health spending account! This article discusses what pharmacogenetic testing is, where to get it, how much it costs, and how to look for a high-quality, clinical-grade pharmacogenetic service you and your doctor can trust.
Precision medicine aims to replace the one-size-fits-all model – in which treatment strategies are developed for the “average” person. From a consumer perspective, precision means therapy tailored to you as an individual. The good news is that one arm of precision medicine, called pharmacogenetics (also known as pharmacogenomics, or PGx for short), is a well-established science that examines genetic variations in drug metabolism.
When a medicine is taken, it is broken down by our body’s enzymes, which are encoded by our DNA. Because of variations in our genetics, our enzymes process (or metabolize) different drugs at different rates. PGx helps to explain why individuals respond differently to the same medication based on their genetics. A drug and dose that works well for one person may cause harmful side effects or be ineffective for another. The most extensive PGx study to date, by the UK Biobank, found that 99.5% of individuals may have an atypical response to at least one drug and 24% have been prescribed a drug for which they are predicted to have an atypical response.
Since most of us (over 99%) have genetic variations affecting drug response, using PGx testing reduces the risk of having to try one medicine, and if that doesn’t work, try another and another. When PGx insights guide prescribing, it reduces the risk of side effects and, for many people, helps avoid treatment failure.
While policymakers evaluate the cost-benefit trade-offs of covering PGx testing for better health outcomes for the whole population, clinical awareness and insurance coverage gaps are beginning to close.
Pharmacogenetic reports are affordable and within reach for many Canadians. They give you and your doctor an evidence-based tool to take a closer look at your prescription medications and how your body processes them. At Pillcheck, we’ve done extensive, published research on how people benefit from pharmacogenetics — showing that people feel better sooner with fewer side effects. Our research is backed up by others, too; for example, a study published by the Lancet showed that pharmacogenetics-guided prescribing leads to 30% fewer side effects.
How often do pharmacogenetic tests need to be repeated?
Many companies offer pharmacogenetic tests in Canada. Some PGx tests focus on just one treatment area, such as pain, or charge you more money to “unlock” other treatment areas. Others, like Pillcheck, are more comprehensive, automatically including drugs spanning a range of categories, including mental health, pain, cardiovascular, gastroenterology, neurology, oncology and more. Because the same set of genes is involved in processing over 70% of all medications, the purchase of one Pillcheck test provides prescribing insights for an extensive list of health concerns. With PGx clinical guidelines expanding over time, Pillcheck regularly adds new drugs to your report. And because your DNA doesn’t change, this provides lifetime value. Reports remain relevant and can be referenced anytime you and your doctor consider a new medication.
With every additional prescription a person takes, the risk of side effects or treatment failure increases. PGx can mean the difference between prolonged suffering—and time off work—and managing a health condition successfully. Thus, for most of us, it pays to be proactive.
Where can I get a pharmacogenetic test in Canada?
PGx tests are available to consumers online, through workplace benefits programs, and at select pharmacy partners:
- You can order directly from a company that offers a PGx service online (with or without a doctor’s prescription or requisition).
- Some community pharmacies or specialized clinics can order a PGx test on your behalf as part of their prescription management services.
- Your group benefits plan may provide coverage or offer access to preferred pricing for the test.
How much does pharmacogenetic testing cost?
Prices range from $300 – $1500 CAD, depending on the scope of conditions covered and how results are delivered and maintained. This indicates that these tests cannot be assumed to be identical or interchangeable. The Pillcheck service costs $599. You can submit the receipt as a medical expense for tax claims or reimbursement through a benefits plan, such as a Healthcare Spending Account (HSA) or Extended Health Benefits.
Not all PGx tests are created equal. Questions to ask:
Is it informative for clinical decisions?
PGx test sensitivity is akin to having high image resolution vs. low resolution. To predict something complex, such as how rapidly the liver converts the drug codeine into morphine (which can be toxic or even fatal if your liver is really, really fast at this!), we need to look at a “team” of genetic variants that work together for this process.
A truly comprehensive test also includes more rare ethnic variants – forms of genes that tend to occur at high frequency within certain ethnic groups. Pillcheck is a consumer-initiated, at-home clinical grade PGx test. It is optimized to maximize sensitivity and specificity (high resolution) and ensure accurate results for the ethnically diverse population in Canada.
At a minimum, a clinical-grade test covers genetic markers (such as CYP2D6) and includes copy number variants (CNV). These are common gene duplications resulting in increased enzyme activity. Some genetic testing services don’t cover enough markers, which could lead to providing false-negative results.
Is my PGx data private?
Some consumer DNA testing providers subsidize the cost of DNA analysis by selling customers’ data to their industry partners. Clinical-grade diagnostic tests are more costly because of stricter privacy regulations.
The Privacy Commissioner of Canada provides a handy checklist of questions you may ask the genetic testing company. In essence, service providers should only ask you for personal information if it is essential to delivering the service. Pillcheck promises to keep your personal and genetic information confidential.
How can I share my PGx results with my doctor?
You should not change your medications based on a pharmacogenetic test until your physician reviews your results. The Pillcheck Pharmacist Opinion Letter helps your physician apply PGx insights to optimize your treatment. Pillcheck enables secure sharing of results with any healthcare practitioner you choose.
- A Pharmacogenetic or pharmacogenomic (PGx) test reveals how you are likely to respond to a medication before it is prescribed, helping doctors choose the safest therapy quickly.
- Pharmacogenetic tests are readily available online, through benefits plans, and select pharmacies in Canada.
- Many private insurance plans cover the cost, and it is an eligible healthcare spending account expense when accompanied by a medication review by a licensed pharmacist.
- Insurance companies typically reimburse PGx costs only once in your lifetime, be sure to select a PGx provider that will serve you well now and support you with potential future medication decisions.
- If the test is comprehensive, you only need to do it once and refer to the results throughout your lifetime.
User considerations in assessing pharmacogenomic tests and their clinical support tools https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133969/
Bousman et al., Navigating the Labyrinth of Pharmacogenetic Testing: A Guide to Test Selection. Clin Pharmacol Ther. 2019 Apr 20. doi: 10.1002/cpt.1432.
Bousman et al., Encountering Pharmacogenetic Test Results in the Psychiatric Clinic. The Canadian Journal of Psychiatry. 2022;67(2):95-100. doi:10.1177/07067437211058847