Abstract
Genomic tests are the fastest growing sector in medicine and medical science, yet there remains a dearth of research on access to pharmacogenomic tests and medications. The objective of this study is to explore providers’ and patients’ experiences and views on test access as well as strategies used for gaining access. We interviewed clinicians who prescribed medications that should be guided by pharmacogenomic testing and patients who received those prescriptions. We organized the themes into the four dimensions suggested by the World Health Organization framework on access to medications and health technologies. Guideline-recommended pharmacogenomic tests for cancer care are generally available, although the timeliness of return of test results is sometimes suboptimal. Accessibility of pharmacogenomic tests is made challenging by the process of ordering pharmacogenomic tests, which is time-consuming. Affordability is a barrier to some patients as expressed by both providers and patients, who noted that the cost of pharmacogenomic tests and medications is high. Acceptability of the tests is high as both providers and patients view the tests positively. Understanding challenges to accessing pharmacogenomic tests will allow policymakers to develop policies that streamline access to genomics-based technologies to improve population health.
Highlights
Precision medicine and genomics-based technologies promise safer and more effective use of pharmacotherapy
We identified 126 providers who had prescribed any of a selected list of cancer targeted therapies from 1 May 2013 to 30 April 2014 using HPHC claims data; the prescription of these agents could be informed by pharmacogenomic tests in accordance with clinical guidelines (Table 1)
It is reassuring that there seemed to be no substantial access issues related to guideline-recommended cancer pharmacogenomic tests when they are available as single gene tests
Summary
Precision medicine and genomics-based technologies promise safer and more effective use of pharmacotherapy. Pharmacogenomic tests can predict which individuals are at risk of toxic response to a drug, thereby minimizing drug-related adverse events and the associated costly consequences, such as hospital admissions [1,2]. Such tests can identify individuals likely to respond to an intervention based on molecular markers. Recommendations from the Food and Drug Administration (FDA), such as the information included in drug labels, the CDC, and national professional organizations are available to aid clinical decision-making around use of pharmacogenomic tests based on evidence [5,6,7,8]
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