Drug managers CVS Caremark, Medco, giving gene tests to gauge drug reactions

SAN FRANCISCO – Medco Health Solutions Inc. and CVS Caremark Corp., pharmacy benefit managers for about 120 million people in the United States, are spearheading the use of genetic tests by offering them to some members before providing certain drugs.
The tests reveal whether people have gene mutations that may affect their response to the medicines, making products such as Bristol-Myers Squibb Co.’s Plavix, the world’s second-best-selling drug, and the generic blood thinner warfarin ineffective or even dangerous.
While some tests have been available for two years, doctors and drug companies have been slow to adopt them or urge their use, said Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif. Now the tests are being advanced by Medco and CVS Caremark in ways that may lead to broader acceptance, Topol said in a commentary published Wednesday in the journal Science Translational Medicine.
“The medical community hasn’t taken initiative, drug companies haven’t either, and it’s left the door wide open for prescription benefit managers,” Topol said in a telephone interview on Aug. 9. “In this country that is a surprisingly potent force, so if they make headway, it has the potential to be quite a strong impact.”
When researchers completed the sequencing of the human genome 10 years ago, many predicted the development would revolutionize medical treatment by allowing scientists to find and treat the underlying genetic causes of disease.
So far, the power to assess how people’s genes will affect their response to particular drugs is much greater than the ability to predict people’s risk of disease, Topol said. While hundreds of genes have been linked to an increased risk of various conditions, the consequences are difficult to unravel. A disease may be caused by different genes in different people, and in many cases multiple genes act together to trigger a disease, Topol said.
By contrast, gene variants that affect how people respond to or metabolize drugs have predictive value, he said.
“There’s been an explosion of new knowledge to guide drug use,” Topol said in the interview. “This area has advanced more in the 10 years since the human genome was sequenced than any other.”
Medco’s program covers 10 million of its 65 million members, said Robert Epstein, chief medical officer for the Franklin Lakes, N.J.-based company. Doctors who prescribe Plavix, warfarin, the breast cancer drug tamoxifen, and two AIDS drugs get a call from Medco counselors, who explain that gene tests are available to help determine if a patient is likely to benefit.
Patients who agree are sent a test kit with directions to help them take a swab of saliva and cells from their cheeks and return it in the mail to a lab, Epstein said. Their doctor will get a report assessing the person’s genotype and predicted response to drugs.
CVS started a similar pilot program July 1 that now includes half a million of its 53 million members, said Rick Schatzberg, CEO of Generation Health, a genetics company, based in Upper Saddle River, N.J., that is majority-owned by CVS and manages the testing program. The company hopes to expand the initiative to 5 million members next year, he said.
Offering these services should cut health-care costs, by reducing the number of complications and halting the ineffective use of medications, Epstein said.
“We cannot continue to afford the blunt way we practice medicine today,” Epstein said. “We’re doing what our payers want us to do, which is get the right drug at the right dose to the right patient.”
Medco and Woonsocket-based CVS charge the employers or health insurers for the tests in addition to selling the drugs they provide, creating a potential conflict of interest, Topol said.
Employers and insurers understand what they’re paying for, and “if they don’t think it’s a good value they won’t participate,” Epstein of Medco said. “Over 250 of our clients believe it’s a good value.”
Medco fell 96 cents, or 2.1 percent, to $45.88 at 4:03 p.m. in New York Stock Exchange composite trading. CVS fell $1.06, or 3.6 percent, to $28.62.