Dr Patty Taddei-Allen and Nick Page Discuss Precision Medicine and Health Disparities

There are potential ways that precision medicine could exacerbate disparities, but it should be used to guide people to the right treatments, said Nick Page, chief clinical and strategy officer, and Patty Taddei-Allen, PharmD, MBA, BCACP, BCGP, vice president of clinical programs and services, WellDyne.

Transcript

How can we ensure that precision medicine addresses and does not exacerbate health disparities?

Page: I don't think we've spent a lot of time yet thinking about this as it relates to disparities in health. You know, certainly what I can share is this and one of the reasons why from a PBM [pharmacy benefit manager] perspective, why we're thinking about getting involved in it, is because we are finding that coverage of these tests is not currently broadly available. So, some of these, we're on the bleeding edge of adopting some of these technologies. And so, many of the medical payers don't offer coverage yet. So, I mean, I think from that particular perspective, it does potentially create disparities, that you may have some health plans or some employers and depending upon segments that there could be some differentiation on that.

What we're trying to do is to break down some of those some of those barriers, right? So, we say, “we see the value from a pharmacy cost containment perspective.” This isn't just, “hey, we're going to offset medical costs,” right? No, we think if we get you on the right medication, maybe the medications are gonna be less—we think we can build out a return on investment kind of model that makes sense to have it as part of the pharmacy benefit.

So, what we're trying to do is to say, “look, where we, where we ultimately see it going is this just becomes part of the prior authorization criteria.” There's just another question that we asked, right? Rather than just saying, “Do you have rheumatoid arthritis? Are you being treated by a rheumatologist? What have you tried and failed?” It's like, “Doctor, have you done this test? Right? To help guide the right therapy.” So, we're trying to make access to these tests more accessible, so that we can remove some of those disparities and it's consistent across. Just this is the way we've got a treat that.

Taddei-Allen: The only thing I would add to that is that there is concern because there's a lot of misunderstanding on what is this or this is genetic testing? Does it need a genetic counselor in order to treat those patients? And there's a lot of health plans out there that have very different coverage policies based on those specific situations, where, unfortunately, some people might lump this kind of stuff under that, which is not necessarily the same thing. And so ,I think it's a valid concern perhaps that there could potentially be disparities but from our perspective, you know, from a PBM perspective, by incorporating it into part of the way we help manage those pharmacy costs, it kind of breaks down some of that barrier determining whether or not there's you know, medical coverage or if it's something that's going to be covered.

Page: If you kind of think about where it falls in the process, it's not really about determining coverage. These kind of questions come after the coverage decisions already been made. So once we've determined that you need treatment for rheumatoid arthritis, we're using this to guide what's the best treatment. Yeah, I think it kind of hopefully removes some of that because again, we're not using these to determine are we going to give you access or not to cover your treatment. We've already made that decision that you qualify for treatment. Now it's just trying to say we're trying to guide what the best treatment for you is. Right? And if based upon race or gender that there is a medication that is best for you, we're just trying to get you on the best treatment for your specific genetic makeup, whatever that might be. Whether it's the genetic makeup of a tumor, the way you metabolize drugs, and there's a lot of different factors depending upon the condition and the test.