New Orleans-based Ochsner Health requires genomic testing for two cancer drugs, which can determine a patient's metabolism to provide better patient outcomes.
A Louisiana law requiring insurance companies to pay for the testing went into effect in January 2022. By July, Ochsner made it a required test for cancer patients receiving two types of chemotherapy drugs. The testing is available in Ochsner's Baton Rouge, New Orleans and Northern Louisiana service areas and will become a systemwide practice in the coming year, Catherine Oliver, PharmD, the system's director of clinical pharmacy services, told Becker's.
Although several health systems recommend genomic testing to patients, most insurance companies do not cover the test. Ochsner and Louisiana are the first to make this testing available to cancer patients through their insurance.
The test tells physicians about the patients' metabolizing rate and possible side effects, which allows them to individually tailor dosages. Currently, it is required for patients who will take 5-fluorouracil and capecitabine, and in the future, the system intends to add irinotecan to the required list, Dr. Oliver said.
"None of our genomic tested patients so far have experienced any adverse events requiring them to visit the emergency department or have an extra clinic visit," Dr. Oliver said. "Since July, we estimate we have saved over 100 patient days. We know the proper dose ahead of time, we reduce their doses as necessary and avoid those consequences."
The testing can have a long-term impact on patient care and reduce cost, according to Deborah Simonson, PharmD, chief pharmacy officer at Ochsner. "There's so much information this test provides that the one-time cost is nothing in the big scheme of things," she said.
The panel, which requires a blood draw, tests about 20 genes, Dr. Oliver noted. "We get a lot of information that can tell us more than how two drugs impact our patient. The test can tell us the impact of patient treatments for depression, pain, high cholesterol, certain antibiotics and of course oncology agents. The panel touches on psychology, neurology, infectious diseases, primary care and around 100 medications. The patient may not use those medications now, but it helps us make decisions going forward."
Genomic testing is still considered an experimental or innovative treatment, according to Dr. Simonson. Currently, there are about a dozen hospitals nationwide using genomic testing in some form on qualifying patients, usually in clinical trials. Dr. Simonson and Dr. Oliver said they are hopeful more legislation will be passed and make it so genomic testing is covered by insurance and more hospitals will start testing patients. They credit Marc Matrana, MD, system director of precision medicine at Ochsner and a leader of the Cancer Advocacy Group of Louisiana, for getting the legislation in place in Louisiana.
Legislation is only the first step toward widespread testing for all patients, Dr. Simonson said.
"Then you have to have a very good governance structure to make sure the right data goes to the right place. We don't give data that isn't actionable," she said. "We created a standardized system that ensures this information is put into medical records so physicians in the future can use it as well."
These tests are an innovative area of medicine, but Dr. Oliver said it is time to use "the preponderance of evidence" already available.
"I think some people think that genomic testing isn't quite ready for prime time, it isn't quite ready for direct patient care application, but we would charge that it is," she said. "There are peer-reviewed and evidence-based guidelines already in place for those drugs and gene interaction. There's a lot known about the human genome. The Clinical Pharmacogenetics Implementation Consortium has 42 guidelines than give recommendations on over 100 drugs with actionable recommendations. We do not provide recommendations where there is not evidence to support good patient outcomes, and so much is already available."