Enter Generation Health. “This is a rapidly growing field that is largely disorganized from a payer perspective,” says Lofberg. He compares his company’s approach to that of a pharmacy benefit manager, which largely took over the prescription business 15 years ago, negotiating cheaper drug prices and developing tools to reduce medication errors and inappropriate prescriptions from physicians. The company will use data from research studies and insurance claims to create models for how to put the tests into use, and then offer those services to payers, such as CVS Caremark, insurers, and employers.
Taken together, CVS Caremark and the two other behemoths in the pharmacy benefits field, Express Scripts and Medco Health Solutions, cover about three-quarters of the nation’s prescription market. They face such tight competition that they are continually looking for new services, such as access to genetic testing. Medco has already waded into this territory, funding studies on genetic testing for warfarin and the breast-cancer drug tamoxifen–some women have a genetic variation that makes them metabolize the drug into its active form less effectively. Medco has already instituted a software program for some of its members that automatically highlights these tests to pharmacists when a patient puts in a prescription for warfarin or tamoxifen.
Generation Health is building a preferred-provider network of labs that perform the different tests. It’s also developing patient and physician educational materials. “Today, if you google a genetic test, there is no simple way for a physician or patient to figure out how to use it,” says Lofberg.
One test Generation Health will explore–and one that is likely to be of great interest–is for the anti-clotting drug Plavix, often prescribed to people given heart stents. To work, the drug must be metabolized into its active form. A study published earlier this year in the New England Journal of Medicine found that about 30 percent of Caucasians have a poorly functioning variant of the gene for a drug-metabolizing enzyme and thus are more likely to suffer heart attacks and die after surgery. “It’s a common drug with a big effect in a significant part of the population, meaning it can have a large clinical effect,” says Marc Sabatine, a physician at Brigham and Women’s Hospital who ran the study.