Helping group plan members find the right pharmacogenetic fit

by Leo Almazora10 Feb 2021

Since last year, Manulife’s Head of Group Benefits, Donna Carbell, has been advocating for a more holistic approach to benefits. Under the vision of the Health by Design model, Manulife would engage plan members with information or nudges toward particular services, with the objective of helping people maintain or quickly return to their optimal state of health.

Now, the insurer has come out with a new program that aims to do just that. Using state-of-the-art pharmacogenetic tests, the Personalized Medicine Program takes out some of the guesswork that comes with finding the right medications, helping plan members get back to their healthy place more quickly.

“If you think about it, sometimes getting the right medication mix is a bit of a trial-and-error process,” Carbell told Life and Health Professional. “It may involve a couple of different changes, and it may involve some unwelcome side effects.”

The spectrum of outcomes associated with incorrect prescriptions ranges from the benign (no curative effect) to the harmful. According to Adverse Drug Reaction Canada, a national non-profit organization dedicated to raising awareness of and preventing such issues, an estimated 200,000 severe ADRs occur in Canada every year, though an estimated 95% aren’t reported. The estimated cost of ADRs to the Canadian healthcare system is between $13.7 billion and $17.7 billion each year.

“What we've confirmed is genetics plays a really big role in how you respond to medication,” Carbell said. “Now it's getting more personalized, treatments can be more precise … it’s really about getting to the right effective medicine and reducing side effects within an accelerated timeframe.”

As Carbell explained, the program is geared toward getting better outcomes for members or covered family who have been prescribed medications for specific health conditions, including mental health conditions, chronic pain, and ADHD, to name some.

The process begins with the covered person going through to the insurance provider website, where they will request a test. They’re given access to an onboarding assessment and time with a pharmacist, during which they can have a conversation to understand their diagnosis, the medication they’re on, and other factors that might be relevant to ensure that prescriptions are a tailored-fit to the individual.

After the onboarding process, a home testing kit will be sent to the individual, who then must send back a swab with a DNA sample. The sample will be tested by an independent testing company, who shares the results with the pharmacist; neither Manulife nor the employer sees the results. The pharmacist then confers with the prescribing physician to come up with an updated recommendation for treatment.

“The program really incorporates your prescribing physician, which I think is great because it doesn’t disrupt care,” Carbell said.

Manulife has been piloting the program for a couple of years, and the resulting health outcomes have been very promising. Among the members they’ve put on the Personalized Medicine Program, nearly half (44%) changed their medication or dosage after being tested. Of those that changed their treatment, they saw improved depression scores as well as improved productivity in the workplace.

Within the context of the current COVID-19 reality, Carbell sees two areas where the program can make a real difference. First is with respect to mental health treatments: through the plan sponsors it works with and claims activity within its disability business, Manulife has seen firsthand how the seemingly interminable cycle of lockdowns has taken a psychological toll on Canadians.

“We think the timing is terrific for those who are experiencing in particular, their first treatment regime on mental health medications,” she said. “We’re really trying to limit that trial and error.”

The Personalized Medicine Program is also significant is that it’s an entirely no-contact healthcare management experience. From onboarding until the final connection to the prescribing physician, everything is done virtually or at least remotely, in the case of the requesting individual receiving the test kit and sending back the sample. Regardless of the sponsor or the plan member, the goal is always to ensure a seamless experience throughout.

“One of the significant results we saw from the pilot study is that the program helped give plan members more confidence in prescribed medication working, notably with respect to first-time medications for family members,” Carbell said. “That’s crucial for someone who’s been recently diagnosed and is in the trial-and-error phase of treatment – the test eliminates some of the variables, because you’re sure that the medicine is fit for your genetics. If they still experience other symptoms, they can productively start a different conversation with their physician.”

Plan sponsors whose benefits programs are under Manulife may confirm with their representatives if the Personalized Medicine Program is available under their EHC – Extended Health Care; once that has been confirmed, plan members who are taking prescription medication for a covered condition may avail of the program. Manulife has also begun to surface the program to plan members who are absent from work through its disability program and, in line with its Health by Design model, is looking for other opportunities to embed it into early intervention programs.

“I think this is a great proof point of Manulife’s whole strategy of transforming our group benefits business,” Carbell said. “We think our role is to focus on health outcomes and helping plan members achieve, maintain, and enjoy their best health possible. It's really a powerful new tool in that intervention toolbox.”