Bringing Personalized Prescribing to the Community Pharmacy

An interview with Brian Hocum, PharmD of Wasem’s Pharmacy who has recently made personalized prescribing available to at-risk customers.

Why do you think genetics is important?
I tell my patients that through DNA technology, we are able to determine what type of drug metabolizer they are. I explain how this information can be used to help predict if they are at risk of having bad reactions to drugs (too much drug exposure) or poor response to drugs (too little exposure to the medication). Genetics is important because it allows Health Care Providers, like myself, to predict who will have “bad reactions” or “poor responses” to medications.

How would you define personalized prescribing in your own words?
‘Personalized prescribing” is the analysis and incorporation of patient specific factors (i.e. CYP450 metabolizing capacity–derived from DNA testing) prior to prescribing, dispensing and/ or choosing new medications (including OTC, vitamins, herbals) and doses. While we typically think of “prescribing” as something only Physicians do, I feel “personalized prescribing” is something we can all embrace; Physician, Pharmacist & Patient.

Why did you decide to launch this program at Wasem’s?
As a Pharmacist working in a community pharmacy, my number one goal is to serve the patients of the community. Our services are what bring patients into the store and they are what keep them coming back for years. Keeping patients safe through more informed medication and dose choices is the best service we can provide and “personalized prescribing” is the best tool I know of to do so.

What efforts have you made to educate physicians and patients in your community about personalized prescribing?
We have in the past and continue to educate the community through newspaper advertisements, co-marketing posters and speaking with community volunteer groups like the Rotary, Lion’s club and retirement centers.

Since pharmacists are able to order laboratory tests in Washington State for the purpose of monitoring drug therapy, I often find that the prescribers are unacquainted with “personalized prescribing.” I send them a fax describing what the genetic results mean, and any alternate medications or dose adjustments that they might considered based on the results. The response has been all positive. Doctors are noting the recommendations in their patient charts. I plan to host a dinner soon for Health Care Providers to educate them about “personalized prescribing.”

You have now made several successful interventions on a patient’s behalf; can you share one of these stories?
Yes, here is one of the first testimonials I received after a successful pharmacogenetic intervention. This patient struggled with adverse drug reactions her whole life, and was relieved that science and technology are finally beginning to understand and incorporate “personalized prescribing:”

“Thank you so much for guiding me through the new way to approach medication. Armed with the letter to my health care provider, I feel confident that finally my doctor will be able to adjust some of my medications. Maybe some day genetic testing will be a routine procedure before prescribing meds. How much misery and money could be saved if we get it right the first time…”

Did You Know?

In March of 2010, the FDA put a warning on the Plavix (clopidogrel) product insert that patients with a certain DNA variation of CYP2C19 (pronounced sip-2C19) were at high risk of treatment failure resulting in major cardiac problems or even death.

CYP2C19 is not just involved in Plavix metabolism, it is involved in the metabolism of ~10% of medications.

Other common medications processed by CYP2C19 include:
· voriconazole
· Prilosec
· Prevacid
· Aciphex
· Nexium
· Soma
· Lexapro
· Silenor
· Dexilant

Embassies Crack Down on Third-party Immigration DNA Tests

Third-party resellers of DNA testing abound on the internet. Unfortunately, many of them are unfamiliar with strict requirements for immigration DNA testing. The problem has become so pronounced that many Embassies are now requiring petitioners to contact AABB-accredited laboratories directly.

Natalie Messelt from the US Embassy in Addis Ababa stated, “A petitioner must independently choose his or her own AABB lab, make the appointment, and go to the collection site directly. The collection site must then send the specimen to the main AABB lab testing site directly,
through the lab's internal, controlled system. Third-party vendors include, but may not be limited to, private companies or clearinghouses that serve as intermediaries to make appointments on behalf of petitioners or beneficiaries. The authority for collecting DNA specimens in the United States resides exclusively with the AABB labs and their directly affiliated collection sites.”

The immigration process is complex and lengthy, don’t risk delays and unneeded additional expenses of retesting – contact the AABB labs directly.

Personalized Prescribing: Making the Most of Medicare Preventive Services

Many people don’t realize that personalized prescribing based on DNA testing is covered by most public and private insurers if a healthcare provider believes it is medically necessary. Be sure to ask about personalized prescribing at your next annual wellness visit.

Medicare offers a number of preventive services, including a free annual wellness visit so your doctor can identify health risk factors and recommend steps you can take to reduce those risks. Your doctor will evaluate your personal and family medical history, as well as current medications, and order tests. (See page 3 for complete description.) The goal of these visits is to prevent disease and to improve your overall health and well-being.

More and more physicians are including medication risk assessments to identify drug side-effects and interactions that may be causing problems along with the standard risk assessments for depression, heart disease, and cancer. If you’re taking four or more prescription drugs or one, such as Plavix, with a warning about genetics on the label, your doctor may order DNA Drug Sensitivity Testing to help optimize your prescriptions. Typically covered by insurance if ordered by a qualified healthcare provider, personalized prescribing helps doctors determine both “drug-to-drug” and “drug-to-DNA” interaction risk.

The comprehensive personalized prescribing program analyzes all the prescription drugs, herbal preparations, and over-the-counter medicines patients are taking for their combined interaction risk, and for their compatibility with a patient’s unique DNA profile.

“With this tool, no longer is it a trial and error proposition as to what drug and dose to prescribe; we can now do it scientifically with a much better outcome for the patient.”

- J.E. Block, MD, FACP, Tulsa, Oklahoma

As the number of drugs an individual is taking goes up, so do the risks of a serious or even fatal reaction. If these drugs are being prescribed by more than one doctor, are self-prescribed, such as herbals, or purchased from more than one source, the risks go up even more.

A questionnaire is now available that allows patients to quickly calculate their risk for adverse drug reactions and treatment failures to help determine if they are a candidate for DNA Drug Sensitivity Testing and a Personalized Prescribing evaluation. Based on information compiled from NIH, the FDA, and www.medsandaging.org, you can download the questionnaire at www.HealthandDNA.com/risk.pdf or request copies for yourself or a medical office by calling 800-523-3080 now.

Sources: U.S. Centers for Disease Control and Journal of the American Medical Association

DNA in the News

Caltech researchers recently developed an artificial neural network from human DNA molecules. They chose DNA molecules because they can act like circuits, computing data, transmitting information and processing it. The team then tested the intelligence of their creation with a series of trivia questions– the test tube brain scored 100%. Learn more in the July 21^st issue of the journal Nature.

DID YOU KNOW?

Human beings differ only in 0.1% of their overall DNA; in the other 99.9%, they are identical. One of the ways our DNA differs the most is in the coding for the enzymes that process the majority of the most commonly prescribed drugs. These enzymes vary more than any others known.
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A complete 3 billion base genome would take only 3 gigabytes of storage space, which would fit on memory cards now commonly used in many digital cameras.
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The codeine product insert warns that nursing mothers may cause harm to their babies if ,like 7% of the population, they have duplications of a gene called CYP2D6.

What is the Medicare Preventive Visit?

The information provided is directly quoted from Medicare.gov

The "Welcome to Medicare" preventive visit helps you and your doctor develop a personalized plan to prevent disease, improve your health, and help you stay well. A few things you should know:

· It's free. There’s no copayment or deductible for the visit.

· It’s easy to use this benefit. Just call your doctor when you sign up for Medicare.

· You can sign up for the visit during the first 12 months you have Medicare. After the first year, you can get a yearly “Wellness” visit for free.

· It’s comprehensive. The visit includes a review of your medical history, preventive tests and screenings, and planning for a healthy future.

· The visit is covered by Original Medicare (Part B) and Medicare Advantage Plans. Under

the new healthcare law, the visit is now free along with a number of preventive screenings and services (like mammograms and colonoscopies).

What should I expect during the visit?

During the visit, your doctor will:

· Record and evaluate your medical and family history, current health conditions, and prescriptions.

· Check your blood pressure, vision, weight, and height to get a baseline for your care.

· Make sure you're up-to-date with preventive screenings and services, such as cancer screenings and shots.

· Order further tests, depending on your general health and medical history.

Following the visit, your doctor will give you a plan or checklist with free screenings and preventive services that you need.

What you should bring to your "Welcome to Medicare" preventive visit:

· Medical records, including immunization records. Even if your current doctor does the visit, gather as much medical information as you can to make sure nothing is overlooked.

· Family health history. Try to learn as much as you can about your family's health history before your appointment. The information will help you and your doctor better understand what screenings you should get and what to watch for in the future.

· Prescription drugs. Bring a list of any prescription drugs, over-the-counter drugs, vitamins, and supplements that you currently take, how often you take them, and why.

Don't delay. Schedule your annual preventive wellness visit today! Ask your healthcare provider, or visit www.medicare.gov for more details.

Healthcare Provider? Ready to Make
Personalized Prescribing Part of Your Practice?
Contact Genelex at 800-523-3080 and ask for a Medical Accounts Specialist. We can help you take the guesswork out of prescribing at no cost to your patients or your practice.

Patient? Is Personalized Prescribing Right for You?
Contact Genelex at 800-523-3080 or visit www.HealthandDNA.com.