By Beckie Fenrick, PharmD, MBA and Jason Peterson, RPh
As pharmacy costs climb and personalization reshapes every corner of healthcare, one question is coming into focus: what if drug therapy could be guided by a person’s DNA?
While not yet standard for most therapies, growing evidence shows PGx’s potential to improve outcomes, reduce trial-and-error prescribing and curb costs. For brokers, TPAs, and plan sponsors, PGx represents an emerging opportunity to enhance benefit design through clinically guided personalization—aligning medications with each member’s genetic profile for better results.
Understanding Pharmacogenomics: How Genetic Insights Improve Drug Therapy
PGx is the study of how genes influence a person’s response to drugs. Differences in DNA can affect a medication’s effectiveness for a specific person. Understanding these variations enables tailored therapy choices and dosing for individual patients.
Traditional prescribing relies on population-level clinical trial data. While effective for most, this approach doesn’t account for individual variability. Research suggests that 25–50% of people don’t respond as expected to certain common medications. This doesn’t mean half of all drug therapy is ineffective—only that when those individuals are prescribed specific medications tied to their genetic variants, they may experience reduced effectiveness or side effects.
Aligning drug selection with genetic insights allows clinicians to prescribe with greater precision. For members, that means fewer failed trials and better experiences; for plan sponsors, it means improved health outcomes. Personalized Medicine in Practice: Where PGx is Transforming Real-World Care
At its core, PGx enables personalized medicine—reducing trial-and-error prescribing and helping ensure the optimal therapy is chosen from the start. Studies suggest that 91-99% of individuals carry at least one genetic variant relevant to PGx prescribing, and PGx-related drugs may represent as much as 18% of all prescriptions.
Here are current applications of this approach to medicine:
- Behavioral Health: PGx can guide antidepressant or antipsychotic selection for patients with severe or treatment-resistant depression.
- Cardiology: CYP2C19 genotyping helps identify patients who metabolize clopidogrel less efficiently, reducing risk of poor outcomes and supporting safer alternatives.
- Oncology: Targeted cancer therapies depend on genetic precision to maximize survival and minimize toxicity.
These early applications show how PGx can transform prescribing from a population-based process into a patient-specific science—improving safety, outcomes, and member satisfaction.
Challenges and Opportunities in Expanding Pharmacogenomic Testing
Widespread PGx adoption remains uneven. Barriers include limited practitioner familiarity, unclear reimbursement policies, and the absence of formal guidance in many clinical practice standards. Most physicians have minimal training in interpreting PGx results, and structured education is still evolving.
Efforts such as the STRIPE (Standardizing Laboratory Practices in Pharmacogenomics) initiative aim to close these gaps by harmonizing standards and resources related to PGx , and fostering collaboration across clinicians, laboratories and payers.
Technology presents another challenge. Many electronic health record (EHR) systems do not capture actionable PGx data, limiting decision support at the point of care. Proposed legislation such as the Right Drug Dose Now Act seeks to modernize EHR infrastructure to support PGx integration.
Even with those barriers, PGx momentum continues to grow. Growing accessibility and public awareness are driving interest for this type of testing, while research networks like the Pharmacogenomics Global Research Network are building an evidence base that could bring PGx into broader clinical use.
How PGx Improves Outcomes and Reduces Pharmacy Spend
Beyond clinical benefits, PGx testing has demonstrated cost effectiveness. Analyses show an estimated $2 saved for every $1 spent on PGx-guided prescribing in select therapeutic areas such as behavioral health, cardiology and oncology.
Savings come from:
- Preventing unnecessary medication switches and failed drug trials
- Reducing hospitalizations and emergency visits linked to adverse reactions
- Improving adherence through better therapeutic matches
More vendors are integrating PGx capabilities into pharmacy benefit workflows:
| Vendor | Description | PBM Integration Status |
| OneOme (RightMed) | Clinical-grade PGx testing solutions embedded in care workflows that can be tailored for PBM integration. | Partnered with PBMs offering clinical decision support. |
| Myriad Genetics (GeneSight) | Behavioral health-focused PGx for drug therapy optimization. | Contracts with PBMs offering integration into clinical workflows. |
| Coriel (Corigen) | Population-scale medication risk management program. | Available for PBM contracting; integration varies by client. |
| BenePrecise | PGx program integrating genetic testing with pharmacist-led personalized medication management to improve outcomes. | Fully integrated with BeneCard PBF’s PBM platform offering real-time insights and clinical consultation for enhanced medication management. |
| BlueGenes | AI-enhanced platform delivering real-time PGx insights at the point of care. | PGx platform with real-time PBM integration through partnership with Levrx. |
| True Rx Health Strategists (True Genomics) | PGx testing focused on behavioral health, pain, and cardiology. | Fully integrated into PBM platform to identify candidates and guide therapy. |
| Capital Rx (Rx Helix) | Comprehensive PGx profiling with home kit and pharmacist consults. | Integrated with PBM enterprise platform Judi, enabling real-time member identification and clinical support. |
| PerformRx | Pilot programs integrating PGx with drug therapy management (DTM) and PBM-managed pharmacy benefits. | Innovative program integrating PGx into medication therapy management workflows. |
| DNAvisit | Technology-powered PGx testing and counseling solution with seamless integration into health plans and PBMs. | Collaborates with PBMs and health plans to offer digital genetic counseling and testing, enhancing personalized medication management. |
These integrations show how PGx is evolving from a niche diagnostic tool into a strategic component of pharmacy benefit management.
The Future of Pharmacogenomics in Pharmacy Benefits
PGX testing is poised to reshape pharmaceutical care by identifying opportunities to improve clinical outcomes. As evidence grows and integration expands, PGx can give plan sponsors new ways to improve member health.
Navion’s clinical experts can help assess PGx opportunities and determine where this precision approach aligns with your pharmacy strategy. Connect with our team to explore pharmacogenomic solutions that deliver measurable outcomes.
