Combinatorial pharmacogenomic guidance for psychiatric medications reduces overall pharmacy costs in a 1 year prospective evaluation

Abstract

Objectives:

The objective of this project was to determine pharmacy cost savings and improvement in adherence based on a combinatorial pharmacogenomic test (CPGx) in patients who had switched or added a new psychiatric medication after having failed monotherapy for their psychiatric disorder.

Research design and methods:

The prospective project compared 1 year pharmacy claims between a GeneSight CPGx guided cohort and a propensity-matched control group. Patients were project eligible if they augmented or switched to a different antidepressant or antipsychotic medication within the previous 90 days. Following the medication switch or augmentation, pharmacogenomic (PGx) testing was offered to each patient’s treating clinician. Pharmacy claims were extracted from the Medco pharmacy claims database for each patient (n = 2168) for 1 year following testing and compared to a 5-to-1 propensity-matched treatment as usual (TAU), standard of care control group (n = 10,880).

Main outcome measures:

Total pharmacy spend per member per year; adherence.

Results:

Patients who received PGx testing saved $1035.60 in total medication costs (both CNS and non-CNS medications) over 1 year compared to the non-tested standard of care cohort (p = 0.007). PGx testing improved adherence compared to standard of care (ΔPDC_CPGx = 0.11 vs ΔPDC_TAU = −0.01; p < 0.0001). Pharmacy cost savings averaged $2774.53 for patients who were changed to a CPGx congruent medication regimen, compared to those who were not (p < 0.0001).

Conclusions:

PGx testing provides significant ‘real world’ cost savings, while simultaneously improving adherence in a difficult to treat psychiatric population. Limitations of this study include the lack of therapeutic efficacy follow-up data and possible confounding due to matching only on demographic and psychiatric variables.

Keywords: :

• Adherence
• Combinatorial pharmacogenomic testing
• Mental health
• Pharmacogenomics
• Pharmacy spend

Transparency

Declaration of funding

The project was fully funded by Assurex Health.

Declaration of financial/other relationships

J.G.W., J.D.A., A.G.M. and B.M.D. have disclosed that they are employees of Assurex Health and own stock in the company. J.M.C. and C.A.A. have disclosed that they are employees of Assurex Health. S.Go., G.L., K.K.P. and S.Ga. have disclosed that they are employees of Express Scripts.

The CMRO peer reviewer on this manuscript received an honorarium from CMRO for her review work, but has no relevant financial or other relationships to disclose.

Acknowledgments

The authors gratefully acknowledge Dr. Sharon Frazee PhD MPH for her comments and contribution toward content. Additionally, we acknowledge Kaitlyn Feeney and Marie Taylor for their contribution toward administrative manuscript preparation for submission.

Previous presentation: 10th Annual NEI Psychopharmacology Congress, Colorado Springs, CO, 13–15 November 2014; American Psychiatric Association, 167th Annual Meeting, New York, NY, 2–6 May 2014.

Notes

*CPGx is a trade name of Assurex Health Inc.