New Orleans-based Ochsner Health was met with some uncertainty when it launched its pharmacogenomic program in March 2022 and became one of the first health systems to standardize genomic testing.
"Those initial conversations, people didn't know what you were talking about and really had a lot of skepticism," Catherine Oliver, PharmD, the system's director of clinical pharmacy services, told Becker's.
More than two years later, as the industry has seen the program's benefit and value, Dr. Oliver said those conversations have gone from "what are you talking about?" to "how do I do this?"
Pharmacogenomic testing, also called PGx testing, analyzes a patient's DNA through a blood or buccal swab sample to determine how that patient metabolizes medication and potential side effects that patient may experience. The panel Ochsner uses identifies more than 25 genes and multiple variants of those genes. This allows Ochsner physicians and pharmacists to tailor patient medication dosage or offer different medication options.
This information is particularly helpful for patients undergoing chemotherapy treatment, which is where Ochsner first implemented policies requiring pharmacogenomic testing to be used.
"There's just so much evidence that it significantly improves safety without negatively impacting the efficacy of the drug within oncology," Dr. Oliver said.
The testing has always been available for any Ochsner provider to use and since the program launched, Ochsner has seen not only an increase in use but an increase in beneficial outcomes.
"We have expanded beyond oncology into the mental health space and for other medications in the primary care space, such as cholesterol medications," Dr. Oliver said. "We are really promoting its value in primary care as well."
One of the unique aspects to Ochsner's utilization of pharmacogenomic testing is how the company's health insurance policy covers the test for Ochsner employees based on medications they have been prescribed or the diagnoses they have.
While an oncology patient will have the testing done through a blood draw during a medical appointment, a relatively healthy patient — who might see a physician only once a year — can self-administer the test through a mail-in buccal swab kit provided by Ochsner's partner lab, OneOme.
Test results are shared in the patient's electronic medical record for review by the Ochsner pharmacists, who can then make medication recommendations to the patient's physician.
"We have built out all of the clinical decision support for physicians. We really made it easy for any provider to be able to use the genetic information to positively impact their patients," Dr. Oliver said. "Once they order a medication that may interact with the patient's genetic results, they're getting an alert. They're getting a pop up [within the medical record] that tells them … a better alternative or if there's a dose adjustment that needs to be made."
Integration into the electronic medical record with pharmacy support is the first advice Dr. Oliver gives organizations asking for insight into building their own pharmacogenomic testing programs.
"Making it easy to order, making it easy for those results to come back and the security of knowing there's a pharmacist involved … really helped our physicians feel more comfortable about ordering it," Dr. Oliver said. "Even if they didn't really know exactly what they were going to do with the test, they knew that they had access to a pharmacist who could walk them through."
Educating physicians aside, Dr. Oliver said the next largest barrier is cost. Elias Obeid, MD, from Hackensack Meridian Health's John Theurer Cancer Center in New Jersey, expressed similar concerns when discussing his center's new molecular testing initiative with Becker's.
Coverage for pharmacogenomic testing varies by state and insurance provider. Louisiana, where Ochsner Health is based, requires insurance providers to cover the testing for certain chemotherapy drugs.
Originally available only in Ochsner's Baton Rouge, New Orleans and Northern Louisiana service areas, testing is now available in the system's Lafayette and Mississippi regions, Dr. Oliver said.
According to Ochsner's website, individuals without coverage can expect to pay around $100 out of pocket for the test, but not more than $350. Dr. Oliver said the system is "advocating for all" to have affordable access to the test.
As Ochsner covers the test for eligible employees under the system's health plan, the system intends to pool that patient population data alongside its data from oncology patients to present a stronger publication with that larger patient volume, Dr. Oliver said. The health system hopes to publish results from a payer perspective that shows the testing's long-term value.
"The overall benefit is decreased healthcare utilization," Dr. Oliver said. That value could come in the form of immediately preventing side effects from chemotherapy drugs or more long-term benefits, such as lowered cholesterol or improved mental wellness from tailored medication doses.
Ochsner is also partnering with other organizations — including Ann Arbor-based University of Michigan and Charlotte, N.C.-based Atrium Health — to demonstrate patient outcomes are not negatively impacted by dose adjustments related to pharmacogenomic testing results.
Her advice to other health systems or physicians wary of implementing a similar program? Do not be afraid of something new.
"It's coming soon and it's coming quickly," she said. "You want to be ahead of that, because patients are going to ask for it."