Future of pharmacogenomics in the PBM industry

2023 Q2 Rx Newsletter

May 26, 2023

What is Pharmacogenomics?

Pharmacogenomics (PGx) is based on studying a person’s genetic profile. This has become increasingly common in the PBM industry as the studying of one’s genetics helps to determine if a person may have adverse effects to medications they are prescribed. Over 90% of patients have some form of DNA variants that impacts their reactions to medicines that they are prescribed. 1

PGx testing is significant when it comes to personalized medicine as it quickly diminishes the need for trial and failure with medications. The cost of care then decreases because of patients not having to take a medication for several weeks and then needing to take an alternative till the patient finds the right drug that works for them.

There are currently over 300 drugs that can be tested through a PGx program, and the list continues to grow each year. Drug labeling can contain information on genomic biomarkers with some of the following:

  • Drug exposure and clinical response variability
  • Risk for Adverse events
  • Mechanisms of drug action

A few examples of drugs on this list are Aripipazole, Bupropion, Citalopram, and Escitalopram. Oncology is the top specialty with over 100 drugs listed that meet the criteria. Second would be psychiatry and mental health.

Cost Barriers for PGx Testing

The concept of PGx testing has been favored amongst the medical and pharmacy field. With that said, costs are a huge factor that has come to play in determining if PGx testing should be completed on the medical or pharmacy side of insurance. The average cost for PGx testing through the medical insurance is around $5,000 while the average cost through the pharmacy insurance is $500. Precision medicine programs fees can typically be built into the PMPM calculations for clients.

PBM’s approach on Pharmacogenomics

Majority of the PBM’s in the pharmacy industry are launching clinical programs that provide PGx testing to help lower costs for the plan and to assist patients with finding the correct medications that work best for them. Over $528 billion is spent on drugs that patients have adverse drug effects.

PBM’s are also carving out the PGx testing by partnering with major data software and laboratories to provide precision medicine care to their clients. FlexHealth is a laboratory that focuses on DNA testing to assist health systems with PGx testing. Another company with a focus on PGx testing is GenXys which provides guidance on a data level. They have a software with PGx data that can then identify drug and gene interactions for patients.

Contact our pharmacy practice to learn more about Pharmacogenomics and how PBMs are building solutions to help lower the cost of PGx testing.



  1. “Pharmacists Play Role in Pharmacogenomics Clinical Services,” Pharmacy Times, accessed May 19, 2023, https://www.pharmacytimes.com/view/pharmacists-play-role-in-pharmacogenomics-clinical-services
  2. “Table of Pharmacogenomic Biomarkers in Drug Labeling,” FDA, accessed April 27, 2023, https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling