Multisite investigation of strategies for the clinical implementation of pre-emptive pharmacogenetic testing

Abstract

Purpose: The increased availability of clinical pharmacogenetic (PGx) guidelines and decreasing costs for genetic testing have slowly led to increased utilization of PGx testing in clinical practice. Pre-emptive PGx testing, where testing is performed in advance of drug prescribing, is one means to ensure results are available at the time of prescribing decisions. However, the most efficient and effective methods to clinically implement this strategy remain unclear.

Methods: In this report, we compare and contrast implementation strategies for pre-emptive PGx testing by 15 early-adopter institutions. We surveyed these groups, collecting data on testing approaches, team composition, and workflow dynamics, in addition to estimated third-party reimbursement rates.

Results: We found that while pre-emptive PGx testing models varied across sites, institutions shared several commonalities, including methods to identify patients eligible for testing, involvement of a precision medicine clinical team in program leadership, and the implementation of pharmacogenes with Clinical Pharmacogenetics Implementation Consortium guidelines available. Finally, while reimbursement rate data were difficult to obtain, the data available suggested that reimbursement rates for pre-emptive PGx testing remain low.

Conclusion: These findings should inform the establishment of future implementation efforts at institutions considering a pre-emptive PGx testing program.

Figure 1.

Personnel responsible for: ordering preemptive PGx tests (A) and communicating PGx test results to patients (B).

Figure 1.

Personnel responsible for: ordering preemptive PGx tests (A) and communicating PGx test results to patients (B).

Figure 2.

Targeting of preemptive PGx testing at institutions by medical service. Shades represent preemptive strategy utilized within each category.

Figure 3.

Genes included in preemptive PGx tests (A) and the drugs informed by preemptive PGx testing at > 1 institution with or without EHR clinical decision support alert/tool (B). * indicates availability of a Clinical PGx Implementation Consortium (CPIC) guideline to guide prescribing. Shades represent test characteristics within each category.

Figure 3.

Genes included in preemptive PGx tests (A) and the drugs informed by preemptive PGx testing at > 1 institution with or without EHR clinical decision support alert/tool (B). * indicates availability of a Clinical PGx Implementation Consortium (CPIC) guideline to guide prescribing. Shades represent test characteristics within each category.