HomebusinesshealthAwards and RecognitionbusinesshealthResourcesBlog
The Callery Group
About UsOur ServicesContact Us

The Next Big Thing in Benefits?
Major insurance providers are looking seriously at covering pharmacogenetic testing

The buzz in the insurance world right now is all about trying to figure out whether genetic testing is ready for prime time when it comes to treating some of the big drivers of benefits costs, such as depression and chronic pain.

From what I’ve heard and read over the last few months, I think the answer is not so much "if" but "when." I don’t think it will be very long before benefits plans routinely cover pharmacogenetic testing as part of the treatment plan for a whole range of conditions.

We’ve talked about pharmacogenetic testing in this blog before, when it was "out there" as a new development and a future possibility. Now, much sooner than many of us might have expected, it’s starting to become a reality for the sorts of conditions that drive the costs of drug plans, absenteeism and disability claims.

The basic idea is simple enough. Each person has a different genetic makeup and may well respond differently to different drugs. Some people will benefit from one drug, but not another. Some people will have side effects from one, and less so from another. Some people require higher doses, some lower. And so on. The promise of pharmacogenetics is to give treating physicians a simple test that will allow them to prescribe the best drug, at the most effective dosage, the first time – without trial and error.

As our friends at Benefits Canada report, at least three major insurance carriers are in the process of running pilot programs in pharmacogenetic testing. Sun Life is working with the Centre for Addiction and Mental Health (CAMH) on a study examining the effectiveness of this type of testing in helping patients on short- and long-term disability choose the medications that will be most effective. Manulife is preparing to roll out a pilot project examining ways to pinpoint the best treatments for chronic pain, depression and anxiety. And Great-West Life is piloting a project focused on chronic pain and mental health.

RBC has gone even further and now covers the cost of pharmacogenetic testing to its group benefits clients.

Let’s be clear, though: pharmacogenetic testing is out there now, and it’s being used every day for a wide range of conditions. It’s almost routine in the treatment of many cancers, for example, and very effective in helping doctors decide what type of treatment will be most effective, in identifying the most appropriate chemotherapy drugs, and in calculating optimal dosages.

In those areas of medical science that have seen the most intensive effort – such as breast cancer – researchers have been able to isolate a few “biomarkers,” which are basically the Holy Grail of pharmacogenetics. What that means is basically that if you have a particular variant of a gene, you get a particular treatment. If you don’t, you get a different treatment. Other biomarkers can more accurately define the form a disease, or variations in a patient’s metabolism, or any of a long list of differences from one patient to another.

We’re not there yet with most medical conditions. But, in many cases, pharmacogenetics can already narrow down the list of available treatments, rule out some treatments, suggest others, manage side effects and tailor dosages more appropriately.

If we look at just one area, such as depression, the potential benefits of “tailor made” prescribing become pretty obvious. Depression is clinically defined as a set of specific symptoms, and patients can have a bewildering array of different combinations of them. Then the physician has to decide whether to treat with drugs, or other approaches such as cognitive behavioural therapy (CBT). If they determine that drugs are the way to go, there are five classes of anti-depression drugs. In just one of those classes, the selective serotonin re-uptake inhibitors (SSRIs), there are again many specific formulations – each of them slightly different. Clearly, anything that will help physicians to pick the best treatment the first time is going to make a big difference in the patients recovery.

Pharmacogenetic testing is already listed as an eligible medical expense under the Income Tax Act, if ordered by a physician, which means you can claim it under a health-care spending account.

The basic question that the insurers are working to answer right now is whether the current science has come far enough to make pharmacogenetic testing routine for most patients diagnosed with things like depression or chronic pain.

And, of course, should it be routinely covered by benefits plans?

The answer – and here again I’m pretty sure the answer is not “if” but “when” – is that if the pilot projects currently underway show that patients benefit significantly, testing will soon become a part of most or all benefits plans. Significant benefit to patients, of course, also means fewer claims for ineffective drugs, and quicker recovery which, in turn, means lower overall claims costs.

If there is a topic that you would like me to write about, please email me at bill@penmore.com.

Copyright Notice

All rights reserved. All of the content herein is the sole property of the Penmore Callery Group, and may not be reproduced, transmitted, or stored in a retrieval system - in whole or in part - without the written permission of the Penmore Callery Group. Links to the originating article at www.callerygroup.com are permitted.

Sample Workplace Harassment Policy

Our friends at Humaniqa have developed a sample workplace harassment policy template, and a sample workplace harassment incident reporting form that they have shared with us. These can be used as guides in developing your own policies and reporting procedures. Download a copy of the policy here, and the reporting form here. (Many thanks to Humaniqa!)

The Buzz Bits
Miscellaneous links to interesting benefits information

Penmore businesshealth e-news - July 2018

What is the plan sponsor’s role in mitigating the opioid crisis?

Feds encouraging Canadians to weigh in on national pharmacare

A pot primer for plan sponsors

Demand for EI sickness benefits rising

Ontario government to become second payer under changes to OHIP+

Personal Emergency Leave – Your Questions Answered

Community Ethics, Big City Expertise

Subscribe to the Buzz Blog

Blog archive

Time To Get Ahead Of The Curve

"We've all been working from home for the last four months and now it looks like we're probably never going to go back to working in the office." It’s a statement I'm hearing every day, as more and more workplaces are discovering that working from home is working out better than anyone ever imagined. [more]

Hitting Reset On The Mindset

We can't afford to think "when this is over." We have a job to do and a chance to step up and really shine [more]

Working From Home

10 ways to communicate effectively in a working-from-home environment  [more]

Managing Paramedical Benefits

Think aboutwhy you offer paramedical benefits in order to manage them effectively  [more]

It's All About The Experience

I thought cell phone dependency was a cliche - until I lost mine far from home  [more]

What Happened When I Lost My Phone

I thought cell phone dependency was a cliche - until I lost mine far from home  [more]

"Mental Health" Doesn't Mean What it Used to Mean

We’re done admiring the problem, and it’s time to take some action  [more]

When There is No Return to Work

An Ontario court has set a limit on employers' return-to-work obligations  [more]

Rooting Out the Root Causes

When benefits fraud gets out of hand, it's a sign of big problems higher up  [more]

Four Key Gaps in Benefits Plans

Annual Sanofi survey zeros in on knowledge gaps in plan management [more]

How to Avoid Falling Through the Generation Gaps

Never mind "the older" and "the younger" generation – there are now five of them [more]

Predictive Analysis and Three Other Trends to Watch

Benefits and wellness programs are never going to be the same again [more]

Pharmacare: A Solution Looking for a Problem

Pharmacare would be such a good idea - if everybody wasn't already covered [more]

When the "Human Side" Gets Right in Your Face

A seriously injured client gives us a whole new perspective on resilience [more]

Is Virtual Health Care the New Must-Have Benefit?

In the age of the smart phone, do we really still need to line up and wait to talk to a doctor? [more]

Three Things I Learned from Doc Martin

When it comes to losing weight, there are a few basics you just can't get around [more]

Top 10 Take-Aways from a Crazy Busy Year

What we can learn from the biggest and most controversial issues we've looked at this year [more]

Engagement is the New Normal

What do employees really want from their jobs? [more]

10 Things You Need to Know about Travel Insurance

How to avoid making the mistakes that could cost you your insurance coverage [more]

How to Give First Aid for Mental Health

There's a new perspective on mental health at work, and it's a real eye-opener [more]

What Else Is In Bill 148 - And Why You Need to Know

There's a lot more to Bill 148 than minimum wage hikes and personal emergency leave [more]

The Next Big Thing in Benefits?

Major insurance providers are looking seriously at covering pharmacogenetic testing [more]

Will Cannabis Legalization Change Attitudes about Testing?

New legal limits for impairment may have a bigger impact than legalization [more]

Avoiding The Dreaded "Claim Rejected"

Benefits administrators are always caught in the middle when claims are rejected [more]

Big Data Takes On Benefits Fraud

Data analysis is starting to make a dent in many benefits fraud schemes [more]

The Chronic Pain Puzzle

Financial costs alone are higher than cancer, heart disease and HIV combined [more]

Financial Wellness: Why Money Management Counseling is Such a Good Idea

Debt counseling and money management education can make a big difference for employees [more]

The Next Big Thing: Mental Health Policy

It's time to get ahead of the curve on this one [more]

Unintended Lessons I've learned about Blogging so far

You never know what's going to happen when you click on a link [more]

Drugs, Alcohol and, Oh Yes, Marijuana

Changing times may require all of us to take a long hard look at our drug-and-alcohol policies [more]

Best Tips For Sleeping Well

If you're just not sleeping well, there are some pretty effective things you can do to make it better [more]

Survey Says: Wellness Programs Improve Overall Satisfaction

It seems that employees' satisfaction with wellness programs spills over into satisfaction with their benefits programs and their jobs in general [more]

Changes Coming to Personal Emergency Leave Laws

Amendments to the Employment Standards Act will significantly increase legally mandated employee leaves [more]

The Good News and the Bad News on Diabetes

We keep hearing about a "diabetes epidemic," but there are things we can do now to improve our odds of beating the statistics [more]

Who's Your "Broker" Working For?

In a world of brokers, agents, advisors and consultants, it's important to stay focused on who's really working for you [more]

The Secret to Really Good Workplace Wellness

Workplace wellness is a way to solve a lot of problems before they even come up [more]

Medical Marijuana - More Questions than Answers

A lack of medical consensus makes drug plan coverage of medical marijuana very difficult [more]

Pharmacogenomics Means Better Prescriptions

A simple DNA test can now help pinpoint which drugs are going to work best for you [more]

Why Airplanes Crash

What one successful CEO learned from air crash investigations – and how it all applies to managing any organization [more]

Not A Delicate Subject Anymore...

How to start the conversation about mental health in the workplace [more]

A Look Inside

There's more to this business that we usually talk about... [more]

Bio What-Now?

Get ready for "generic" biologics. [more]

What You Don't Want to Say to Your Doctor

There are some things that you want to explain to your doctor, and some things you really should stay away from. [more]

Your Dentist's Pet Peeve

Why you should know all the ins and outs of your dental insurance plan before you ever lean back in the chair and open wide [more]

About that Credit Card Travel Insurance

It may be of some value, especially if you have no pre-existing conditions, but you really need to read that fine print [more]

Right Drug, Right Time, Right Cost

Why you should work with your doctor, your pharmacist, and your drug plan to make sure you get optimal treatmenty [more]

Big Smiles

A focus on dental plans will ensure that everyone remains happy [more]

Your Doctor Doesn't Know Everything

When it comes to prescriptions, patients need to be part of the conversation [more]

Prescription for Disaster

Advances in pharmaceuticals are threatening your drug plan [more]

Sleep Easy

Conditions like sleep apnea can be treated, ensuring proper rest and productive days [more]

Easy as EAP

Formal support makes a big difference when employees face personal challenges [more]

Well Done

10 ways to develop an effective workplace wellness program [more]

Mind Matters

Businesses can't afford to ignore the mental health of their employees [more]

Brian's Story

Brian Callery is celebrating 40 years in our business. It's a commitment that makes a difference in his clients' businesses [more]

The Benefits to You

The same plans designed to protect employees will also offer advantages to employers [more]

Lawyer Up

There are legal ramifications around changing benefit plans - especially if an employee is being terminated [more]

Travel Trauma

Dream vacations can turn into nightmares when travel insurance claims are denied [more]

Evolution Solution

Evolving benefit plans will meet employee needs and support recruiting and retention efforts [more]

Plan & Predict

How rising paramedical claims, drug reforms, and other trends will affect your workplace benefits [more]

Who Benefits

Education makes the case for workplace benefit plans [more]

Season of Renewal

Important questions to ask your benefits advisor before inking a deal [more]

Preventive Measures

Paramedical services help keep employees healthy, on the job, and productive [more]

A Bounce in Their Step

Canada Rubber Group employees are embracing their new wellness program [more]

Business Benefits

Shandex Group and Indaco Manufacturing discuss the value of evolving employee benefits plans [more]

A New Mindset

Workplaces can't afford to ignore the mental health of employees [more]

Cost Cutters

10 cost-cutting strategies to protect your benefits plan [more]

Safe Travels

12 ways to protect yourself on your next vacation [more]

Breaking News

Learn from the mistakes of an AOL executive when discussing any changes to your benefits plans [more]

Watch the Gaps

Protect against turnover and lost opportunities by recognizing the generation gaps [more]

Generation Next

Generation Y represents the future of your business - and will see workplace benefits plans in a different way [more]

Absent Minded

Employers are paying the price for absenteeism, but it can be controlled [more]

Think Positive

Programs that build positive workplaces make business sense [more]

Back to School

8 important lessons your employees need to learn about benefits plans [more]

Find a Better Broker

6 questions you should ask anyone who wants to sell you a benefits plan [more]

Plan Your ROI

5 ways employee benefits plans can deliver a real Return on Investment [more]

The Benefit of Benefits

3 ways a benefits plan can improve your company's bottom line. [more]

A Healthy Dose of Information

5 questions for your pharmacist that might save your drug plan and your wallet. [more]

Claim Denied

Consider these 8 ways to avoid rejected benefit claims. [more]

Travel Planning

6 questions to ask before assuming you are protected by a group plan's travel insurance. [more]

Biologic Logic

Growing list of biologic drugs could bankrupt poorly protected drug plans. [more]

Smart Shopping

8 shopping habits that will protect your benefits plan. [more]

Tough Medicine

Employees will share more responsibilities and higher costs to sustain their benefits. [more]

Crime Costs

5 scams that could be placing your benefits plan at risk. [more]

A Prescription for Your Drug Plan

Skyrocketing drug prices may be threatening your benefits plan, but generic drugs offer a cure. [more]

Planes, Trains and Travel Insurance

The fine print in your travel insurance may leave you more exposed than you think. [more]

Healthy and Wealthy

5 steps to an employee wellness program that will generate real financial returns. [more]

Avoiding Burnout During Holiday Season

Education and Prevention can help control spiraling benefit costs. [more]

Sweat the Small Stuff

Protect your staff by avoiding these common "paperwork" mistakes by administrators. [more]

Services Personal Services Corporate Services