Upsetting categories? The consequences of pharmacogenomics for making knowledge-based reimbursement decisions in Sweden

Abstract

This paper contributes to an understanding of pharmacogenomics-in-the-making by foregrounding a regulatory setting in which these technologies must be situated: decision-making about pharmaceutical reimbursement. Health care assessment organizations have been introduced in many countries to systematically address the issue of health care coverage. Using the example of Sweden, the process of deciding reimbursement status is shown to hinge on the creation of stable and clinically feasible categories of patients, diseases and drug responses. Through a series of analogous examples concerning conventional pharmaceuticals, it is argued that current mechanisms for categorizing reimbursable drugs could be upset when pharmacogenomic advances provide a means of making patients more specific objects of regulatory intervention. By extension, this has implications for the form of solidarity that is produced.