Description of an Established, Fee-for-Service, Office-Based, Pharmacist-Managed Pharmacogenomics Practice

Abstract

OBJECTIVE: To describe an established, pharmacist-managed, fee-for-service, office-based pharmacogenomics (PGx) practice.<br/> SETTING: Multi-specialty, academic, tertiary care medical clinic and hospital.<br/> PRACTICE DESCRIPTION: Physician office-based PGx fee-for-service (FFS) pharmacist practice. Patients seen are complex and most are older adults.<br/> INNOVATION: Established service in a new area of ambulatory practice that is financially self-sustaining. Patients who received PGx testing were seen within the medication therapy management polypharmacy practice since 2015, with the PGx practice becoming official in 2018.<br/> MAIN OUTCOME MEASUREMENTS: Growth of practice, evaluated by referred patient consults ordered per month by providers.<br/> RESULTS: Because of insufficient third-party payment for PGx services, the practice was developed as a selfpay, FFS practice and growing because of patient and provider demand.<br/> CONCLUSION: It is quite possible pharmacists in greater numbers can expand PGx services into ambulatory and inpatient areas they may have never otherwise entered now that PGx has grown in use and relevance. PGx presents additional opportunities and service lines for pharmacists to practice how they were trained and assist them in collaborative integration onto the medical team.

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

“…10 Several surveys of pharmacists have reported enthusiasm for testing and provision of PGx services, but raise concerns about their knowledge/preparedness and reimbursement. [11][12][13][14] The pharmacist delivery model may be implemented in different settings, such as hospitals, 15 community pharmacies, 16 clinical offices, 17 and nursing homes. 18 In addition, pharmacists may assist in the delivery of PGx testing through a PGx consultation service, 19,20 specifically assisting with test ordering and interpretation of test results.…”

“…The pharmacist delivery model may be implemented in different settings, such as hospitals, 15 community pharmacies, 16 clinical offices, 17 and nursing homes. 18 In addition, pharmacists may assist in the delivery of PGx testing through a PGx consultation service, 19 , 20 specifically assisting with test ordering and interpretation of test results.…”

Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic

“…Thus far, pharmacogenetic implementations have largely taken place in research hospitals [ 9 ] or academic medical centers [ 10 , 11 , 12 , 13 , 14 , 15 ], which often have the financial means and access to trained personnel necessary to facilitate pharmacogenetic testing and its integration into practice. In addition, teaching environments foster interdisciplinary collaborations and engagement with physician champions, two key pieces that have been shown to be essential for longevity of pharmacogenetic services [ 16 ].…”

Current and future state of clinical pharmacist‐led precision medicine initiatives

“…This is especially true in older adult populations, where polypharmacy is common. 33,57 Investigators from the INGenious trial suggest the need for studies focused on providing data on the cost-effectiveness of PGx programs and their ability to capture and quantify adverse events, compare adverse event rates with national averages, benchmark costs per adverse event, and analyze the accuracy of adverse event recording. 58 Funding for PGx programs, grant opportunities, and mentor-mentee participations is also required to facilitate research.…”

“…Accordingly, pharmacists are ideally suited to discuss with patients and providers the test benefits, risks, and potential limitations.Although several medical disciplines can affect patient care, pharmacists are uniquely positioned to lead interprofessional teams pertaining to PGx and optimal medication selection, given these nuanced complexities. This has, in turn, allowed pharmacists to develop clinical consult services and clinics that allow for interpretation of PGx results 15,17,26,32,33.…”