We’ve been discussing the migration to precision medicine in several of our blog posts lately, outlining how some GDBHT mental health and substance use partners are meeting patients where they are. One exciting field that is equipping providers to offer individualized mental healthcare is pharmacogenetics. 

Pharmacogenetics provide additional data on a patient's response to medications. Dr. Daniel VanDorn, PharmD, Sr. Medical Science Liaison and Lead Scientist for Product Development at Genomind, enlightened us on these topics and the innovative ways that Genomind is increasing prescribing confidence, reducing healthcare costs, and improving patient experiences.

Population health is at the top of many peoples' minds these days, what is the role of precision medicine in population health?

Precision or personalized medicine is a care model designed to optimize efficiency and therapeutic benefit for patients. Precision medicine often involves genetic testing to reveal how a patient may metabolize certain medications or determine the potential impact medications can have on the body. However, it is not yet commonplace for health care providers to have access to genetic information, while other factors can be used that are more widely accessible.

In addition to genetic factors, drug-drug interactions (DDIs) are the most common, preventable cause of adverse drug events (ADEs). ADEs harm over 2 million people and cost the US healthcare industry $30B annually. Up to 22% of all patients taking medications are predicted to have DDIs, with estimates up to 31% in the elderly population. While there are tools available to health care providers that assess DDIs, they are infrequently and disparately utilized across our health care system.

Imagine if we could quickly identify, within a large data-base of health information, specific subpopulations of patients at greatest risk of drug-drug interactions, while also providing therapeutic alternatives to reduce this risk. Now imagine that we can also identify those patients at greatest risk of harm due to potential genetic factors, and thus stratify which patients are suitable candidates for genetic testing. This is exactly what Genomind’s precision technology was designed to do.

Why is pharmacogenetics important in mental health?

Mental illness impacts 20% of the U.S. population and that percentage is quickly growing across every age group. Individuals who are prescribed mental health medications often are subjected to a trial and error approach to treatment. For far too many patients, this results in months or years of struggling with unresolved symptoms with the added burden of ADEs. Real-world data suggests that 67% of people with depression do not achieve remission with their first medication trial, with the odds of remission declining after each subsequent trial. Depending on the condition, 30-80% of psychiatric patients have unresolved symptoms. Many abandon drug therapy altogether, usually due to adverse drug effects. There is an obvious need to embrace tools that limit trial-and-error, reduce risk of ADEs, and improve patient outcomes. Pharmacogenetics is one such tool.

Pharmacogenetics (PGx) refers to the study and application of how an individual’s genetics may influence their response to medications. This is far from a new concept. Other fields of medicine such as oncology and cardiology have applied PGx for years, which has since evolved into a standard of care in these fields.

Similarly, utilization of PGx in psychiatry has grown over the past few years due to its potential to decrease treatment by trial and error. A recent meta-analysis (study of studies) showed that depressed patients were 71% more likely to achieve remission when PGx was used to personalize their treatment, compared to those subjected to the standard approach. Similar studies suggest that PGx can reduce the rate of hospitalization by 50%.

PGx can provide additional data for healthcare providers to tailor treatment to the individual. The Food and Drug Administration (FDA) has identified over 270 medicines with genetic-based guidance on their manufacturing labels. Additionally, the Clinical Pharmacogenomics Implementation Consortium (CPIC) has reviewed more than 400 gene-drug pairs, and has produced peer reviewed PGx guidelines related to many mental health treatments. So how can we responsibly prescribe medication without having this information about our patients?

This more personalized and informed approach to treatment has been associated with higher remission rates, decreased healthcare costs and reduced hospitalizations. Our challenge now is to broaden awareness and increase the adoption of this practice, especially within mental health.

Tell us more about your innovative approach at Genomind and the adoption you have been seeing?

As the science of medicine evolves, Genomind feels a keen sense of obligation and responsibility to evolve with it. We maintain the latest medication guidance within our models and continually optimize our laboratory processes. We have also expanded our solutions to support not only individual patient care, but the management of large patient populations, which will continue to grow in importance and focus within the healthcare industry.

Genomind’s Population Health solution is driven by GenMed✓Pro, Genomind’s precision gene-drug-drug interaction software. The proprietary logic that drives GenMed✓Pro is now being applied to large healthcare databases to assess the full drug regimens of populations en masse. This allows payors and large health care institutions to identify individual patients at greatest risk of harm due to DDIs. The software then provides a list of alternative medications which may be less risky, as well as specific FDA or CPIC guidance where appropriate.

In addition to identifying known drug interaction risks and alternatives, we also apply a genetic prevalence algorithm that calculates the probability of gene-drug related risks. This further allows these institutions to stratify their population by probability of genetic risk and identify individual patients for whom PGx testing may be warranted. Our full platform can be seamlessly integrated into any workflow through our numerous EMR / EHR partnerships. We are making it easier and faster to personalize treatment in a way that hasn’t been done by the competition.

Genomind has served over 300,000 patients in providing personalized, psychotropic medication guidance. Our tools are accessible to over 100M covered lives including Medicare, Medicaid, and several Commercial insurers. We work with, or are actively engaged with, employer benefit brokers, telehealth/psych companies, PBMs, behavioral health carve-outs, care management solutions, and ACOs covering over 51M lives. We look forward to increased adoption in the future and plan to help lead this change.      

Genomind’s value-proposition to the healthcare market includes:

• Increase Prescribing Confidence: 95% of Genomind clinicians report they can now make safer, more informed treatment decisions with a higher level of confidence.
• Reduce Healthcare Costs: In a case-control study, Genomind-guided treatment was associated with 40% fewer emergency room visits, 58% fewer inpatient hospitalizations, and an estimated $1,948 reduction in health care costs over 6 months.
• Minimize Adverse Drug Events: Our platform can help you proactively manage medications, optimize treatment plans, and identify a personalized course of action from the start.
• Increase Medication Adherence: In a case control study, Genomind-guided therapy was associated with significant improvements in medication adherence.
• Improve Patient Experience: In a clinical trial, 87% of patients who received Genomind-guided treatment reported clinically measurable symptom improvement.