Pharmacogenomics is the study of how genes affect drug responses in patients. Because pharmacogenomics is still in its infancy and U.S. healthcare systems have not yet adopted it, the financial burden often falls to patients to pay for genomic testing. However, as pharmacogenomic testing becomes more common, it is unclear who should finance these tests. Should the burden of paying for pharmacogenomics fall to the patient, or is this the responsibility of the government and healthcare payers? 

Who Should Pay for Pharmacogenomics?

According to Kate Merton, Head of Commercial Development at Navigate BioPharma, we should consider which group will benefit most from pharmacogenomics. At first glance, the patient appears to be the primary beneficiary of pharmacogenomics because they receive customizable treatment plans that account for their genetic background. Kate adds that the healthcare payer may also see a monetary benefit. This is because pharmacogenomics allows the payer to get patients on the most appropriate treatment plan much quicker—decreasing the overall cost of covering that patient. 

The Role of Early Adopters

Despite the monetary benefits that healthcare providers may receive, patients will be the ones paying out-of-pocket for pharmacogenomics, at least initially. This is because pharmacogenomics is still in its early stages and the healthcare system has not yet integrated genomics testing. This is to be expected, says Kate Merton, and early adopters are typically willing to pay for genomics tests. The motivation behind this is often curiosity—whether that be knowing more about their ethnic background or for personal health reasons. As pharmacogenomics continues to develop, Medicare or large employers may cover the costs of genomic testing—taking some financial burden away from patients.

Why Hasn’t the U.S. Adopted Pharmacogenomics?

One barrier facing U.S. adoption of pharmacogenomics is the lack of genetic data available to patients, providers, and healthcare payers. Compared to countries with socialized medicine, the U.S. does not have access to as many genetics and disease datasets, and cannot easily determine the cost benefit analysis of adopting pharmacogenomics. This means that the U.S. may not experience the same pharmacogenomic development that countries that offer socialized medicine may. This may mean that U.S. pharmaceutical companies will have to be more imaginative and driven to make sure the speed of their uptake matches international companies.

Although patients and healthcare payers may finance genomic testing, this may end up changing further down the line as the U.S. healthcare system adopts pharmacogenomic testing. As pharmacogenomic testing becomes more common, the financial burden may end up falling on pharmaceutical companies and healthcare payers—lowering costs for patients.

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The opinions stated in this blog are the sole and present opinions of the blogger and do not necessarily represent the opinions of the Kulkarni Law Firm, PC and/or its attorneys. Such opinion(s) may change over time. Such opinion(s) should not necessarily be attributed to the institution for which these individuals may work or otherwise represent in any capacity. These blogs do not constitute legal advice and should not be construed as such.