Pharmacogenetics Testing: Smart Medication Management

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Garrett Huxall, Pharm.D, CGP, FASCP Executive Director, PharmCareOK

As a pharmacy consultant with over 20 years of experience and now nursing home owner, I understand that medications and their side effects can critically impact a patients’ care. To aid physicians in their management and choice of medications for various disease states, I have been utilizing pharmacogenetics testing and it allows me to recommend proper medication therapy more quickly and accurately.   The tool from PGx Medical replaces the “trial and error” process consultants cannot afford in a nursing home setting.

I have numerous stories on how a pharmacogenetic (PGx) test report impacted my dosage recommendation or regimen changes. However, small adjustments in dosage or selection of a new pharmaceutical agent with guidance from the PGx report, have lead me to now select medications that can be properly metabolized. Where in the past, I would have just gone to the next drug and hoped for a better outcome.

Below are three case studies I have written:

Case Study #1 – [88 year old female Alzheimer patient that was on Aricept, Namenda and Zyprexa because she was frequently falling]. After getting the pharmacogenetics (PGx) test report, we determined she needed a few med changes based upon her genetic profile. There were certain mutations within her system that were not allowing the medication to provide therapy.  With the physician’s approval, we immediately transitioned her to a different drug, Geodon. She responded very well to this medication.  Now, we have even been able to reduce her dosage of Geodon and she has not fallen since.  This is a great outcome as she is on a lower dosage of medication than she was prior to us using the pharmacogenetics test results.

Case Study #2 – [Male patient, multiple med, pain regimen not providing therapy]. This patient was on Lortab, Asprin and an NSAID for several months. Patient continued to complain of strong pain and medication dosages were increased with no effectiveness in pain reduction. Upon requesting a pharmacogenetic test, patient was placed on Dilaudid. Once we reviewed the test results, we were able to lower his dose of Dilaudid, twice daily while continuing with Asprin.  Before the test he was taking Lortab, Asprin and an NSAID. We reduced the patients’ pain medications by 50% and he is doing much better. In reducing the medications by 50% we are also helping to eliminate many of the complications often associated with heavy dosages and large regimens of pain medications. We were also able to reduce the cost of treatment to medicare for this patient.

Case Study #3 – [Male LTC resident on multiple medications]. This patient was only on Allopurinol and was then prescribed Lipitor and had a reaction. They thought his reaction was more of a psychotic reaction so they prescribed him Geodon. The patient had a severe reaction and tried to strangle his father. He was then admitted to a Psych Hospital. We then ordered a pharmacogenetics test to determine if his body could even metabolize the medications.  By the enzymes we found, the Geodon or any of the new atypical drugs weren’t going to work for him.  So we put him on Thorazine and got him calmed down.  We then started reducing the Thorazine and now the patient is back on Allopurinol for gout and that is the only prescription medication he is taking. Great outcome!

Previously, without the PGx testing results to guide us, this change may have taken several different methods and a longer time frame to achieve results. It was very reassuring and validating to me that we were able to intervene on a much quicker basis and helped, which is a benefit to the clinical team and the medical director.

Educating the clinical team and medical directors at the facility on the value this tool provides is crucial, as there is no out of pocket costs for residents covered by medicare (and medicaid in select states). It’s important to reassure residents and family members that the medications they are taking are the most appropriate and able to provide proper therapy. A less medicated, cognizant, mobile resident allows for the home to be more efficient and profitable.

For more information on pharmacogenetics testing, contact PGx Medical at  info@pgxmed.com or 405-509-5112

Budget Crisis in Oklahoma: Being Efficient With What You Have

A projected 25% cut in Medicaid provider payments could go into effect June 1 and elderly Oklahomans will be hit hardest in a state already ranked as worst in the country for healthcare access.

 

So the big question is…what can we do to help offset these budget cuts?

The Oklahoma Association of Health Care Providers said the cuts would likely leave more than 90% of the state’s nursing homes operating at a loss and in danger of closing. (more…)

Pharmacogenetics: What makes PGx Medical different?

Are you considering implementing pharmacogenetics in your day-to-day patient care?  If so, do your research.

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As we travel across the country educating healthcare professionals on our PGx Medical Metabolic Validation Program, we hear over and over again about other companies in the market.  Our response?  We are grateful that healthcare professionals are taking the first step in learning more about pharmacogenetics and the benefits it will provide their patients and staff.  And the long-term cost savings to the overall healthcare system.  But, have they really done their homework and researched each company to find out what they provide?  And most importantly, are they doing it in an ethical manor?

At PGx Medical, that’s all we do is pharmacogenetic testing.  Our team of consultants are here to educate you on a tool that is available to help your patients live longer…better.  We’re not here to tell you what you should do, or how you should treat your patients.  We’re here to help you implement a program into your practice or home that will give you direction when dosing your patients.  And that doesn’t always mean reducing medications – which could happen.  But most importantly getting your patients on the “right” medications.  Right drug, Right dose, Right person, that is our goal.  And once testing is complete, we continue to maintenance the program so it is part of your day-to-day patient care.

But one of the biggest differences we hear over and over again is we give our clients the whole picture.  At PGx Medical, we test 8 panels and report on 19 genes and receptor sites.  Do we get reimbursed for all these genes?  No.  But we would only be giving you part of the puzzle if we only reported on the genes we are reimbursed on.  Ask yourself, would you only treat a patient with subpar care?   We wouldn’t either.

We also offer, free of charge, many services after testing that make it easy for your team to review results and make any necessary medication changes.  Not to mention, our results are back within 48 hours from the time our laboratory receives your buccal swab sample.  And when you are working in the LTC setting, or with geriatric patients, you can’t afford to wait two weeks for results.

We encourage our clients to do their research.  Know who they are doing business with and know if a company offers them money in exchange for their services, it may not be legal and may be considered an inducement.

Just do your due diligence so that at the end of the day, you know, you are giving your patients/residents the best care possible and you are receiving all the necessary information to help you provide the best standard of care.

For more information on PGx Medical, contact one of our team members:

PGx Medical
Individulaized Care – Personalized Medicine
LeadingAge OK Partner
405-509-5112
info@pgxmed.com

PGx Medical and Pharmacogenetic Testing

PGx Medical provides test results that provide clinicians with valuable patient-specific information to make better therapeutic treatment decisions.

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Pharmacogenetics uses information about a person’s genetic makeup, or genome, to choose drugs and drug doses that are likely to work best for that particular person.

What causes so much variablity in drug response among individuals?
Much of the variation in drug response is a result of genetic differences and drug interactions in addition to environmental factors such as diet and lifestyle.

How do genomic differences cause this variablity?
Research shows that genes of the cytochrome P450 family directly correlate with how individuals metabolize many common psychiatric medications.  If a clinician knows ahead of time tht a resident would metabolize certain drugs too quickly (UM) or slowly (PM), they can make more informed medication decisions and reduce the likelihood of side effects and medication failures.

How does PGx help a clinician with medication management? 
PGx Medical provides the clinician with a personalized report indicating which medications may be more or less appropriate based on the individuals metabolic profile.

Which genes are analyzed? 
We analyze multiple genes of the cytochrome P450 family linked to a person’s metabolic capabilities for many medication categories.  In addition to cytochrome P450, we analyze 19 genes associated with medication response.

Which medications are included in the reports? 
Over 100 of the most commonly prescribed, FDA-approved medications in the following categories:
Behavioral Health:  Antidepressants, anti-anxieties, and anti-psychotics
Pain:  Analgesic medications
Cardiovascular:  Cardio and anti-coagulants

Is it affordable? 
Medicare B covers 100% of the testing cost and PGx Medical does not balance bill.  We also have medicaid coverage in many states.  In addition, many commercial insurance plans reimburse for the testing.

How do I get more information on the PGx Medical Metabolic Validation program? 
Contact one of our consultants across the country.
Call: 405-509-5112
Email: info@pgxmed.com

RIGHT DRUG, RIGHT DOSE, RIGHT PERSON

LeadingAge Oklahoma Partners with PGx Medical

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In our promise to inspire, serve and advocate for older adults in Oklahoma, LeadingAge acknowledges the need for education and adoption of innovative technology and solutions for culture change. We are very proud to be an association of members who are forward-thinking and redefining the traditional “standards of care”. Members who are embracing a new standard that allows residents to Live Longer… Better.

LeadingAge Oklahoma is excited to announce our strategic partnership with PGx Medical. PGx Medical’s President, Clay Bullard, spoke at our Spring Conference a few weeks ago and was very well received.

The PGx Metabolic Validation Program allows for a personalized/unique patient report validating the patient is getting the right drug, in the right dose, for the right diagnosis based upon how each individual patient metabolizes certain medications. This helps eliminate unnecessary medications, reduce possible side effect, help maintain mobility, reduce falls and avoid drug on drug interaction that can have significant and often negative effects.

PGx Medical helps facilities and communities gain an understanding of the role metabolic validation testing can and should have within the care provided to older Oklahomans. They also educate the facility owners, physicians, administrators, and staff as to the value the test results can have on the bottom line and helping their residents be more active and age in place.

We chose to partner with PGx for three very specific reasons. First, we have seen in many of our members’ facilities that this tool can have a tremendously positive effect with residents they serve. Secondly, PGx has been advocating with the Oklahoma Dept. of Health – LTC Division (under former leader Dorya Huser and now Director Mike Cook) with ongoing training for the State Surveyors and speaking at the State Education Symposiums throughout the 2014 calendar year to help with CMS Psychotropic Med Reduction and Unnecessary Med Reductions Initiatives. Thirdly, this technology should inspire us all to look at what we are doing and realizing that new tools are available to provide better care and accessible with no cost to our members.

Finally, I encourage you all to reach out to PGx Medical to have them educate your team of caregivers on the value this tool can provide. Work with your physicians and encourage them to work with you to provide the best care possible with the best tools available.

The PGx website is www.pgxmed.com and they can be reached via phone at (405) 509-5112. I am more than happy to give you my insights on the value this tool affords our members and you can reach me via email at mary@LeadingAgeOK.org.

Join me in welcoming PGx to the LeadingAge Oklahoma family, and embrace the technology they provide to help us all fulfill our promise to be forward thinking in enhancing the level of care we provide the residents of Oklahoma we serve.