May 18, 2010 
Genetic testing (aka pharmacogenomics, personalized medicine) is certainly a hot topic these days. There is lots of research around how to use the testing to manage drug spend by appropriately matching drugs with genetics at the individual member level.
I find it interesting to see who’s going to the “prom” with whom here. Another interesting perspective is how physicians feel about these (see survey).
- Medco acquired DNA Direct.
- CVS Caremark hired Per Lofberg from Generation Health and invested in the company.
- P&G invested in Navigenics.
- Walgreens was going down the path with Pathway Genomics before the FDA intervened.
So…what is Express Scripts doing? I’ve heard some talk at a conference about their strategy which involves a broader focus on integrating data from multiple sources including genetic testing to help drive clinical decisions. It seems like they’re either late to the party or smart in staying away. The question is whether this is a nice to have, a differentiator, or something that consultants will start requiring the PBM to provide. From their 2009 Outcomes conference:
[Genomics and personalized medicine] The potential for improved outcomes and cost savings are attractive but still unproven.
Enabling Healthy Decisions 
Interesting topic, George. Regardless of the pros and cons of PBMs in this space, it is clear that this enables independent PBMs to capture a new revenue stream – by adding a genetic testing line of business. It will be great to test this business model against a more holistic health and total cost of care approach and see what really drives appropriate utilization and best cost.