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The role of pharmacogenetics for the benefits sponsor community

Veronika Litinski, MSc Medicinal Chemistry, MBA22 Sep 2021

This article by Veronika Litinski, CEO of GeneYouIn, the company behind Pillcheck, was published in Benefits and Pensions Monitor in February 2021 under the title “Speeding Up Plan Evolution: COVID And Pharmacogenetics”. Below is a summary of the article, followed by what has changed since it was published.

Click the image below to read the full article or download the PDF.

Benefits And Pensions Monitor - February 2021 http://www.mirabelsmagazinecentral.com/DigitalEdition/index.html?id=cd2ad482-36b3-49e3-8cb7-de271f4e2ba6&pn=17&pv=d

What does the article cover?

The article looks at how the COVID-19 pandemic put pressure on employers and benefit plans. Many people continued to have symptoms for months after infection, and some developed chronic conditions or disabilities. Plans already had many tools, such as health spending accounts, extended health coverage and disability management, but faced constant cost pressure and did not want to duplicate what the public health system already provides. The author argues that the best benefits strategy supports plan members with the right help at the right time, with as few steps and as little friction as possible.

The article then focuses on mental health, one of the largest drivers of disability claims. Depression affects many plan members, particularly between the ages of 30 and 50, and finding an effective medication can take a long time because each trial lasts weeks. Pharmacogenetic (PGx) testing looks at genes that affect how people respond to many of these medications, and a pharmacist trained in pharmacogenetics can combine the results with the person’s medication history to advise their physician.

Key points from the article:

A randomized trial. In a trial sponsored by Green Shield Canada in Canadian community pharmacies, people with depression or generalized anxiety disorder whose treatment was guided by pharmacogenetic testing improved more than those who received standard treatment.
Altered enzyme activity is common. Among long-term disability claimants with mental health claims who were tested between 2018 and 2020, only 22% had normal activity of both CYP2D6 and CYP2C19, two key enzymes that break down many mental health medications.
Beyond mental health. Proton pump inhibitors (PPIs), among the most prescribed medications in North America, are also broken down by CYP2C19, so people with reduced CYP2C19 function clear them more slowly. The article also mentioned early pandemic reports linking higher PPI doses with COVID-19 infection; evidence on this link has since been mixed.
Lifetime value and easy access. Because DNA does not change, a pharmacogenetic report stays useful for life and can be updated as guidelines expand. The article described offering testing directly through benefits, much like an employee assistance program request, with a personalized report, a pharmacist’s review and action plan to share with the doctor, and free updates.

What has changed since 2021?

The trial was published. The randomized trial mentioned in the article was published in 2021. Over six months, participants whose antidepressant treatment was guided by pharmacogenetic testing had greater improvement in depression, anxiety and disability than those who received standard treatment.
Stronger evidence for panel testing. In the large European PREPARE study of 6,944 patients, published in 2023, prescribing guided by a multi-gene pharmacogenetic panel lowered the odds of clinically relevant side effects by about 30%.
Updated guidelines. The Clinical Pharmacogenetics Implementation Consortium (CPIC) updated its guideline for antidepressants in 2023, covering CYP2D6, CYP2C19 and other genes.
Broader coverage. Pillcheck has expanded its panel and now reports on 24 genes and 355 medications.

For current information on how pharmacogenetic testing can help shorten mental health disability claims, read 78% of mental health disability claimants are on the wrong medication. That’s a fixable problem.

How can a Pillcheck test help?

A Pillcheck test reports CYP2D6, CYP2C19 and other genes that affect antidepressants, pain medications, heart medications and many others. A pharmacist reviews each person’s results together with all their medications and prepares recommendations to share with their prescriber.

Pillcheck testing is performed in CAP- and COLA-accredited clinical genetic laboratories located in Canada. Pillcheck reports on 24 genes, increasing coverage with new guidelines and drug labels (see the genes tab), and covers 355 medications, which account for over 70% of dispensed prescriptions. The Pillcheck test panel ensures high accuracy for people of non-European and admixed ancestries. Your results last a lifetime, and report updates are free of charge.