Personalized Medicine

According to Dr. Eric Topol, director of Scripps Translational Science Institute in La Jolla, PBMs have emerged as leaders in the Personalized Medicine Services market. PBMs plan to make money by selling personalized medicine services to employers, which are willing to pay them higher fees for improved health outcomes and lower prescription costs.

Medco Health Solutions recently acquired DNA Direct, a leader in genomic medicine. This acquisition allows Medco to deliver a comprehensive suite of Precision Health Services™. Medco’s program covers 10 million of its 65 million members, according to Robert Epstein, chief medical officer for the 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 Caremark started a similar pilot program July 1 that now includes half a million of its 53 million members, said Rick Schatzberg, chief executive officer of Generation Health. Generation Health, a genetics company, 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.

CVS Caremark and Generation Health recently announced 13 drug therapies that will be included in the initial offering of their integrated Genetic Benefit Management service. The companies said they are offering the industry’s first Best Test Genetics Network, which coordinates pharmacogenomics testing for members of CVS Caremark’s network.

CVS Caremark, earlier this year, also announced the appointment of Per G.H. Lofberg as president of its pharmacy benefit management business. Lofberg has more than 30 years experience in health care and the PBM industry including the role of Chairman for Merck-Medco Managed Care LLC, which later became Medco Health Solutions. He most recently served as President and CEO of Generation Health Inc.

Express Scripts approach, according to CEO George Paz, is something the company does every day. Patient advocates and the company evaluate each of its members’ adherence, their drug regimens, gaps in coverage and then address those issues. Express Scripts’ works with the client and figure out who is in the best position to deliver the care needed to improve that individual’s healthcare outcome. If the care needed is better delivered through the disease management program by providing the health information from the managed care company and the PBM too, the company wants to be part of that solution.

Express Scripts is advertising for a Director – Pharmacogenomics. The primary role of this position is to work cross-functionally to develop new and innovative clinical products in the area of personalized medicine and programs to enable better health and value to members. Also, working with internal stakeholders and external entities to proactively evaluate new products and assist in the development of those products for its plan sponsors.

Where does this leave the smaller PBMs without the resources necessary to enter this market. Although they may be at a strategic disadvantage in some ways, increasing their focus on their core competencies and seeing how the market evolves may best serve them.