Implementation of Pharmacogenomics

Testing in Shoppers Drug Mart #976

Eisha Vijay (APPE Student)
Preceptor: Saliman Joyian
November 26, 2020
Table of
ContentsINTRODUCTION PROJECT TIMELINE
01 Describe PGx project
details
02 Overview of project
timeline

PGx PROCESS FINDINGS

03 Explain the PGx
implementation process
in the pharmacy
04 Statistical and qualitative
data

DATA ANALYSIS CONCLUSION

05 Interpretation of the data
06 Summary of the project
findings
 01
INTRODUCTION
 PGx Testing Service Project Details
Objective: Assess the ease of implementing the PGx service for pharmacists and see
what types of patient population would we be interested in PGx Testing service

Our Goal:
○ Understand the pharmacist’s role for providing PGx service
in community pharmacy
○ Raise awareness about PGx service in our pharmacy
○ Identify patients that will benefit from PGx service
○ Confidently introduce and discuss about PGx service with
patients
○ Able to interpret PGx lab results
 02
PROJECT TIMELINE
 Project Timeline
Recruited patients using
Training Modules Personalized Patient Criteria List Finalize the findings
October 26, 2020 November 9, 2020 November 23, 2020

November 2, 2020 November 16, 2020 November 20, 2020

Recruited patients using Follow up with PGx Testing on
Eligibility Report interested patients Saliman
 03
PGx IMPLEMENTATION PROCESS
Training Modules
PGx Power Users Clinical and
Technical Training
● Online Clinical Training Modules-
provided history of
Pharmacogenomics, CPUC
guidelines and case studies

○ Module A:
 Issues concerning the Eligibility
Report
• Every week, total of 6-9 patients were on the eligibility criteria
Small number of list
patients • Not enough patients to contact for the PGx service

• Patient that were 3 and 18 years old were included in the list
Irrelevant patient age • Limited evidence available for interpreting PGx results for
groups children

• For example, patients that were on Januvia, Perindopril,

Irrelevant medication Synthroid, Amlodipine, Tadalafil were tagged on this list
categories • No CPIC guidelines are currently available for these drug
categories
Interested Patients using Eligibility Report

0%
How can we change that?
Personalized Patient
Criteria List

Age groups between 30-60 years old

Private Insurance or Cash-paying

On anti-depressant, mood, anxiety, pain,

clopidogrel or proton pump inhibitors

Goal: Targeted approach in identifying patients interested in PGx

Testing who will have the highest clinical impact
 Raise Awareness
● Distribution of Flyers to raise awareness
● Created guidelines for pharmacist Team to increase involvement
● Success rate? Unclear as of now, since we have so far given out atleast 15-20 flyers and still are
waiting for response
 Obtaining Eligible Patient Report
(using Patient Criteria List)

Time Duration: 1-1.5 hours/day

Flag Age Identify those Retrieve any Obtain 12-15

Obtain Groups: on selected medication eligible patients
Transaction List
30-60 years old medications history to call per day

Individually Manually flagged Checked each Assessed each List of 12-15 eligible
selected patients that were flagged patient’s selected patient’s patients to call for
insurance provider between 30-60 profile for selected profile for any PGx service per day
in the last month years old medications: changes to
(October 2020- antidepressants, medication therapy
November 2020) anxiety, mood, pain, in the past
clopidogrel or proton
pump inhibitor
 Introduction of PGx Service to
Patients

“Have youa heard

Perform quick about
“Pharmacogenomics our
medication new service
review
testing called
to assess
is a DNA pharmacogenomic
test if
to the patient
assess howhas
experienced
certain genes can testing
sideaffect theinbefore?”-
effect the past
way Eisha
or
the drugstruggling with their
is metabolized in the
body. This may incurrent medication
turn affect therapy
the efficacy of the drug and may
“No! What is it?” - Patient
lead to side effects. Are you interested in knowing about this
service?”- Eisha
PGx Service Discussion with Interested
Patients
PGx Service Cost : $450 through Shoppers
Drug Mart

DNA Cheek Swab Procedure and Lab Result

Details

Pillcheck website and Insurance coverage

Benefit of targeted approach for prescribing based on

their individual PGx report
 04
FINDINGS
Common Responses from Patient
What if my results come
Is it covered by my Do I have to do this back saying everything is
insurance ? test every time? normal ?
Yes, it can be if you have a No, this is a one time DNA test That is a possibility but at least
Healthcare Spending Account. since your genes do not change you would know that if a
You will need to confirm with over time. Your lab report will drug was not effective or you
your insurance company . be annually updated as newer experienced side effects, it was
evidence is released. not due to your genes.

Where do I read up Can you email me what Do I need to speak with

more about this I my doctor about PGx
service?
Shoppers Drug Mart is affiliated need
Sure! I to
can ask myan email
send you It isservice?
not necessary but I
with Pillcheck company to provide with insurance?
the Pillcheck website and would definitely encourage
this service. You can check the the reimbursement details. If the speaking with your doctor
Pillcheck website for further details. insurance company needs more to see if this service is
information, I can assist you. appropriate for you.
Daily Interested Patients using
Patient Criteria List

42% (5 out of 12 patients per day)

 Statistics
Total number of calls= 75 patients

Medication Profile of Eligible Patients

90%
83%
80%
70% Antidepressants/
Anxiety/ Mood
97%
60%
Pain Private Insurance
50% Proton Pump
Inhibitors
40%
Clopidogrel
30%
20%
13%
3%
10%
3% 1% Cash-paying
0%
Medication Profile
 Statistics
Total number of interested patients= 15 patients

Medication Profile of Interested Patients

80%
73%
70% 46 Average Age
60% Antidepressants/
Anxiety/ Mood
50%
Pain
Proton Pump Inhibitor
1 Cash-paying
40%
Clopidogrel
30%

20%
20% 2 Patients opted out
10% 7%
0%
0%
Medication Profile
 Outcome
● Cost is the biggest hurdle, since many patients do not want
to pay out of pocket
● 2 patients opted out:
1. No insurance coverage for PGx service
2. Change of mind after consultation with family
physician
● Insurance confirmation pending for the 13 interested
patients
○ Wait time: 2-4 weeks

No patient confirmation for PGx service as of now!

 05
DATA ANALYSIS
Suggestions for
Targeted Age Group
improvement to PGx service for children is controversial with limited amount of evidence to
Eligibility Report interpret the clinical significance so they should be omitted from the list.

Appropriate Medication Categories

Based on CPIC guidelines, there are dosing recommendations available
mostly for antidepressants, anxiety, chronic pain and clopidogrel. But, there
is limited evidence for heart and digestive conditions.
Focus on changes in medication
therapy
Almost all interested patients were struggling with their current medications
or experienced in the adverse effects in the past.

More patients on the list

5 out of 12 patients were interested based on Patient Criteria List. Having at

least 20 patients on the list can increase the possibility of interested patients.
Marketing Strategy
What is Pharmacogenomics?
• Create a standard digital information email link for patients which pharmacist can
email them
• The email will contain:
• Details about the pharmacogenomics service with link to Pillcheck website
• Next steps for interested patients ie. Check plan information for coverage of
pharmacogenomics testing service
 06
CONCLUSION
SUMMARY

TARGETED ELIGIBILITY REPORT

Target patients that may Despite being red, Mars
benefit from the service is a cold place

DIGITAL RAISE AWARENESS

INFORMATIONAL EMAIL
LINK
Easier access to Make patients more familiar
information for patients with Pharmacogenomics
 INFOGRAPHIC
01
Mercury is the
smallest planet
02
Mars is actually
a cold place
03
Jupiter is the
biggest planet
04
Saturn is the
ringed one
THIS IS A MAP

Mercury is the closest

planet to the Sun and
the smallest one

Despite being red, Mars

is actually a cold place
full or iron oxide dust
KPI DASHBOARD

452
Shops retailers
$28
Avg. price per unit
771
Units inventory
 KPI DASHBOARD

PEOPLE
80%

SALES
70%

MARKET
To modify this graph, click on it, follow the link,
60% change the data and paste the new graph here
STATUS REPORT

SCHEDULE The project schedule is on track

RESOURCING Resourcing is adequate

BUDGET Project is within budget

RISKS All project risks are under control

ISSUES Project issues need to be solved

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THANKS
Do you have any questions?
[email protected]
+91620421838
yourcompany.com

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