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Medco Says 'Specialist Pharmacists' Can Help Docs Recognize PGx Opportunities for Oncology Patients

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By Turna Ray

This story was originally posted on Jan. 26.

The implementation of a new information system at Medco Health Solutions' Therapeutic Resource Center is expected to allow pharmacists to play an unprecedented role as an intermediary between cancer patients, doctors, and laboratories by recognizing opportunities for pharmacogenomic testing.

The pharmacy-benefits manager last week announced that approximately 150 "specialist pharmacists" will manage cancer patients by identifying treatment gaps, managing drug side effects, and addressing quality-of-life issues at its oncology Therapeutic Resource Center, or TRC, headquartered in Whitestown, Ind.

In conjunction with the launch of this program, Medco unveiled a new information management system, called Advanced Oncology Solutions, that will alert pharmacists and physicians to potential adverse drug reactions, current clinical data, and pharmacogenomic opportunities for specific treatments.

In a statement, Medco said that within its new program pharmacists will play a “more central role in improving health outcomes for patients with common forms of cancer,” as well as reach out to special needs populations, such as children with cancer.

“Identifying a dangerous drug-drug interaction or identifying a gap — either omission or commission — in a patient's medication regime are extremely important areas where the pharmacist acts as liaison in bringing needed information to both physicians and patients, Milayna Subar, Medco’s national practice leader in oncology, told Pharmacogenomics Reporter via e-mail last week, "That said, the PGx testing addition is truly unique and is bringing a level of insight to physicians that will allow for practicing more precise medicine at the onset of treatment.”

Medco, one of the largest PBM's in the country serving 60 million people, has been a pioneer in the implementation of pharmacogenomically guided personalized medicine. The company is already offering PGx testing services for widely prescribed drugs, such as warfarin and tamoxifen, to 200 customers serving 7 million lives. Separately, Medco launched the Genetics for Generics program last year, which aims to use genetic testing to increase healthcare savings in the administration of certain generic drugs [see PGx Reporter 10-07-2009].

Within the TRC, when a pharmacist recognizes a pharmacogenomics opportunity for a patient who receives pharmacy benefits through the Advanced Oncology Solutions information network, the pharmacist would then discuss this with the patient's physician and manage the implementation of genetic testing.

“The pharmacist would also serve as a liaison between the physician and the patient and the laboratory to ensure the testing is scheduled, performed, that the results are received by the physician,” Subar said. Finally, the pharmacist would “support the interpretation of the results and application to treatment decisions.”

This enhanced role for Medco pharmacists will be facilitated through Advanced Oncology Solutions, a program under which Medco's oncology clinical experts from its specialty pharmacy, Accredo Health, will support pharmacists at the TRC in Whitestown.

Both specialty and general pharmacists will gather information on patients' conditions and treatments through an information support network aimed at keeping patients compliant with their prescribed drugs and minimizing adverse reactions. While Medco's oncology specialty pharmacists will oversee the proper administration of anti-cancer regimens and supportive care, the non-specialty pharmacists will monitor the overall safe administration of oncologics and drugs for other conditions.

“Cancer patients, who take on average 10 different oral medications, including those used to treat other chronic conditions, are at risk for drug interactions that could render an anti-cancer drug less effective,” Medco said in a statement. “When enrolled in Advanced Oncology Solutions, information systems alert pharmacists and physicians to potential hazards, the latest clinical expertise, and pharmacogenomic opportunities.”

“The [PGx] opportunities will be built into our systems with rules sets that will be flagged for the pharmacist,” Subar said. She added that Medco's oncology specialist pharmacists receive training with regard to handling PGx information, are educated on the latest clinical data on genetic tests, and are informed about prominent gene-drug interactions.

Subar cited a Medco/American Medical Association survey reported last year that showed that while 98 percent of physicians understand the value of PGx, they don't feel they have the sufficient knowledge to comfortably order such tests. “That's where the pharmacist will play a vital role,” Subar said.

Last year, Medco performed several PGx studies in oncology. In one study, Medco researchers looked at how the co-administration of antidepressants metabolized by the CYP2D6 enzyme and tamoxifen affected cancer recurrence patients. In the study, tamoxifen-treated patients on antidepressants that are strong CYP2D6 inhibitors (ie. Prozac, Paxil, and Zoloft) had a 1.9-fold higher risk of cancer recurrence than those on weak CYP2D6 inhibitors (ie. Celexa, Lexapro, and Luvox).

Another Medco PGx study assessed whether chronic myeloid leukemia patients were being tested to establish their BCR-ABL gene status while being treatedwith Gleevec. The study found that only 14 percent of patients had their BCR-ABL gene measured in consecutive quarters and 60 percent had one genetic test performed over a period of one and a half years.

These findings led researchers to conclude that “physicians are not conducting necessary follow-up gene testing for Gleevec patients to determine whether the treatment is working.”

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