Can genetic testing lead to better health outcomes and lower plan costs?

How personalized medicine could change the health care landscape

In Canada, we spend over $30 billion annually on medications1. But recent studies point to an alarming fact: many medicines simply don’t work for individual patients. When it comes to medical treatment, one size does not fit all.

Treating an ailment or illness can often involve a frustrating process of trial and error, experimenting with various prescribed medications to discover one that functions well. And this process can be dangerous. Some patients can experience adverse side effects, while others can discover a drug to be ineffective, allowing their illness to progress unchecked.

For example, when treating depression, 40 to 50 per cent of people don’t respond to the first antidepressant they’re prescribed2. And it’s estimated that anywhere between 24 and 90 per cent of patients who are prescribed a medication for mental health don’t stick to their therapy due to side effects they experience3. This becomes a major barrier to treatment and recovery.

Pharmacogenetics offers a potential solution

Pharmacogenetics is the study of how an individual’s genes influence their response to medications. By using this specialized genetic testing, it’s possible to determine which drug may be used to best treat an individual to deliver the optimal therapeutic effect with the least side effects.

In short, pharmacogenetics may change the future of health care by personalizing medicine for each patient based on their DNA.

The upside is significant. For patients, the benefits include the following:

  • Lowering the risk of adverse drug side effects
  • Improving the effectiveness of medication in treating a disease or condition
  • Finding effective treatments for serious diseases and conditions more quickly, avoiding the trial and error process to medicine

When it comes to treating heart disease, cancer, mental illness and other serious conditions, the potential benefits cannot be ignored, particularly in comparison to how medications are typically chosen for patients today.

Pharmacogenetics can also change the landscape for drug plans

The use of genetic testing may also lead to more streamlined drug plan designs and reduced costs for plan sponsors. The ability to personalize treatment could simplify the prior authorization/step therapy process, potentially leading to faster access to the right treatment.

What’s more, faster access to the right treatment could lead to quicker improvement in the patient’s condition, resulting in reduced drug waste. And this could add up to lower drug costs – and lower benefits costs – down the road.

It’s not a done deal… yet

While it may seem clear genetic testing offers potential benefits for both plan members and sponsors, there are still some issues to resolve before it becomes standard practice in our health care system, let alone part of group health and drug plans.

How reliable is the testing?

We need to ensure consistent and accurate results are available to patients and medical professionals. While the industry is progressing, we’re not there yet. Plus other factors besides genetics may also influence an individual’s response to a medication – and we need to better understand the complex relationship between genes and environment. 

Is the testing widely available?

In addition to providing access to many Canadians, widespread, reliable testing will help promote a cost effective framework. While the potential benefits seem significant, reasonable costs will help create a tipping point.

What is the government’s role?

Regulations are definitely needed to establish guidelines and standards for pharmacogenetics. Plus, the field of pharmacogenetics is not to be confused with DNA testing designed to predict illness. Clear rules are required to help unlock the opportunity, while also protecting privacy and ethical considerations for Canadians.

Who pays for the testing?

Given the potential advantages, genetic testing could be covered by benefit plans in the future. But there’s much more information and work required to get to that point. It’s still a relatively young field and patients today must pay for any testing on their own.

Monitoring progress in Canada

Manulife is working closely with the Canadian Life and Health Insurance Association (CLHIA) and with provincial governments to help shape policies that will guide our future. We’re also following developments in the field and investigating the science behind the testing.

Overall, we believe pharmacogenetics offers potential to improve plan member health outcomes while also lowering plan sponsor costs. This evolving and developing field presents a significant opportunity to change the group health plan industry.

There’s still work to be done. But as policies and guidelines crystalize, we’ll be ready to adapt to the changing landscape. 

To learn more about the Canadian pharmacy landscape, visit manulifebalance.ca