As genomic medicine evolves, health systems are embedding pharmacogenomics into pharmacy operations, not only as a research function but as a clinical asset to personalize patient treatment and reduce adverse effects.
Here are responses from four pharmacy leaders who were asked: What is one way your health system has integrated genomic medicine into pharmacy operations?
Note: Responses were lightly edited for length and clarity.
Aniwaa Owusu Obeng, PharmD. Senior Director of Pharmacy Pharmacogenomics Program at Mount Sinai (New York City): At Mount Sinai Health System, our pharmacogenomics (PGx) program advances precision medicine through three pillars: clinical implementation, research and education. Clinically, PGx-trained pharmacists, in partnership with medical geneticists and genetic counselors, deliver results and counseling through a two-visit model in the Genomic Health Clinic. On the research front, we have contributed to national efforts, including the COAG trial, eMERGE-PGx consortium, and IGNITE network, and most recently developed a mobile app with the Hasso Plattner Institute for Digital Health to return PGx results in a patient-friendly way. This app is now being tested against pharmacist-led counseling in a randomized, non-inferiority study. Education is equally central: Since 2014, we have offered PGx rotations for students and residents. In 2023, we launched an internal certification program that has already trained nearly 60 pharmacists. Together, these initiatives advance our PGx Vision 2030: to ensure every pharmacist across our health system is PGx-trained and -equipped to lead precision medicine implementation.
Tim Lynch, PharmD. Senior Vice President and Chief Administrative Officer at MultiCare Health System (Tacoma, Wash.): MultiCare oncology pharmacists are assuming an increasing role in the review of genetic testing, working collaboratively with oncologists and other care team members to enhance patient outcomes. Our pharmacists review therapy plans, laboratory results, pathology reports and genetic testing results received after diagnosis. They ensure alignment with nationally recognized pathways, protocols and schedules. They also evaluate dosing appropriateness for each patient and assess safety concerns, including drug interactions and potential adverse effects. An example of this collaboration is when a provider selects a drug that does not target a specific mutation, the pharmacist partners with them to identify more suitable alternatives.
As genomic and germ cell testing continue to advance and become more prevalent in oncology, we see a shift to oral chemotherapy and specialty medications which we have aligned with our specialty pharmacy to enhance access and better care coordination. We have embedded specialty oral oncology pharmacists into our oncology clinics so they can help coordinate with insurance providers when a covered medication does not target a specific cancer mutation by providing supportive literature and evidence for the use of a better targeted therapy. We have had success in overturning insurance denials through this collaboration and improved patient outcomes.
Ericka Ridgeway, PharmD. Director of Pharmacy, Population Health and Ambulatory Clinical Services at Henry Ford Health (Detroit): One major way Henry Ford Health has integrated pharmacogenomics into pharmacy operations is through clinical decision support (CDS) tools built into Epic. These tools are used across multiple specialties to help providers identify patients who may benefit from testing, interpret pharmacogenomic test results and guide treatment decisions, particularly for medications with a high risk of adverse effects or failure.
Currently, CDS for pharmacogenomic testing is embedded or in development within oncology, cardiology, primary care and behavioral health. For example, in GI oncology, we’ve added pharmacogenomic testing to all treatment plans involving certain chemotherapy drugs. This helps us identify patients with an enzyme deficiency that could make those drugs life-threatening. In cardiology, patients who have suffered a heart attack can undergo pharmacogenomic testing to better personalize their antiplatelet therapy, reducing the risks of bleeding and drug failure and improving access to high-cost medications.
Meanwhile, in primary care and behavioral health, we are developing pre-testing best practices to improve remission rates for depression, minimize adverse effects and enhance patient satisfaction. We plan to build on these efforts and expand to additional specialties in the future.
Mark Sullivan, PharmD. Senior Vice President and Chief Pharmacy Officer of Vanderbilt Health (Nashville, Tenn.): Genomic medicine is integrated into pharmacy operations via a team approach to generating the data via research and lab testing efforts, building actionable clinical alerts for vetting by our clinical alerts experts, and providing at the elbow support to our clinicians as needed to identify the best therapeutic option for patients based on their genomic profile.
