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What We Do
What is Precision Medicine?
Precision medicine utilizes an individual’s genetic makeup to identify the most effective course of therapy to treat both acute and chronic conditions. This approach takes into consideration drug-gene interactions, drug-drug interactions, age, gender, and lifestyle factors.
Pharmacogenomics: The Key to Precision Medicine, is the application of how genes affect an individual’s ability to metabolize medications. It is a tool that helps providers customize a medication treatment plan designed to provide the best possible outcome while minimizing potential side effects and adverse drug reactions.
A Clinical Genomic Pharmacist collects white blood cells found in saliva from the inside of a patient’s cheek using a buccal swab.
The swab is sent to a federally certified (CLIA) lab specializing in pharmacogenomics. Using open array technology and top of the line software, the genetic lab team is capable of identifying over 60 alleles present on 18 different genes directly related to the metabolism of over 300 medications.
Approximately 5-7 days after collection the results are released to the Genomic Pharmacist and time is scheduled to meet with the patientand their providers to discuss the report and associated recommendations. This interdisciplinary team approach allows theopportunity to create the most personalized medication therapy regimen possible.
Precision medicine can help replace the trial and error process that exists today where providers prescribe drugs and dosage levels based on general population data, the one size fits all approach.
How PGx Testing Works
The Pharmacogentic test uses DNA from buccal cells to detect the presence or absence of gene markers. These gene markers have been identified as indicators of how a patient will metabolize given medications. Our scientific team uses open array technology to identify 60 alleles present on 18 genes that determine the metabolism of over 200 medications. Importantly, the price of the Pharmacogentic test also includes a Personalized Medication Review with a pharmacist trained in pharmacogenomics. During the, the pharmacist will interpret the report for physician, caregiver and the patient. The pharmacist is required to coordinate medication recommendations with you, the prescribing physician. Patients are told not to discontinue or make any changes to their medication without first consulting their provider. Pharmacogenetic testing does not replace the physician’s role in determining medication therapy.
Pharmacogentics testing makes the field of pharmacogenetics possible. With pharmacogenetics focusing on how your body metabolizes certain medications based on your genetic profile, pharmacogenomics is the broader category relating to the study of genetic variations that influence an individual’s response to drugs.
Why Is PGx Testing Important?
PGx testing provides patients and physicians with a profile of genetic variances that will assist in designing a treatment plan to reduce the occurrence of adverse drug reactions (ADRs) and side effects. Until recently, the only options for physicians were to prescribe medications based upon population data with a “one-size fits all” approach. Unable determine how a patient’s genetic profile influences the assimilation and metabolism of medications. Today’s medical advancements in PGx now allow physicians and providers alike the opportunity to better understand how a patients genetic profile may interact with specific medications, thus a more effective drug treatment plan can be set in motion to improve quality of life and reduce overall medical costs. As our healthcare system moves to an outcome-based model, Precision Rx Consulting offers healthcare professionals a new drug sensitivity testing tool to help inform your medication treatment decision by providing you information specific to your patients’ genetic profiles.For patients being prescribed new medications or taking multiple prescriptions, we can help you better understand how your patient may respond to a particular drug, which may have potentially life-altering or perhaps even life-saving benefits.
Why is PGx Important :
✔ The FDA advocates for clinical pharmacogenomics due to its potential to increase efficacy and safety when prescribing medications.
✔ Up to 50% of the medications we take are ineffective and/or potentially harmful.
✔ 29% of Americans take five or more medications, dramatically increasing the risk of ineffective therapy and/or adverse drug reactions.
The Benefits of PGx Testing
✔ Physicians can be confident they are selecting optimal therapy and reducing the current practice of “trial-and-error”
✔ Improve the selection of drug targets
✔ Patients know they are taking the Right medications thereby increasing patient compliance
✔ Medication therapy is shifted from reactive to proactive
✔ Overall cost of Healthcare is reduced Read More
✔ Forensics to potentially explain overdoses when the standard has been prescribed and administered.
Healthcare Arenas Benefitting from PGx Testing:
✔ Psychiatry/Psychology – antidepressants, anxiolytics, antipsychotics, etc.
✔ Cardiology – Warfarin, Plavix, beta-blockers
✔ Transplant – Azathioprine
✔ Oncology – Tamoxifen, chemotherapeutic drugs
✔ Pain Management – Opioids
The American Medical Association on Pharmacogenomics and Personalized Medicine:
“One of the most important components of personalized medicine is pharmacogenomics, the study of genetic variations that influence individual response to drugs. Enzymes responsible for drug metabolism and proteins that determine the cellular response to drugs (receptors) are encoded by genes, and can therefore be variable in expression, activity level and function when genetic variations are present. Knowing whether a patient carries any of these variations may help health care professionals individualize drug therapy, decrease the number of adverse drug reactions and increase the effectiveness of drugs.“
Precision Rx Consulting partnered with RxGenomix, pharmacogenomics services company, was developed specifically to give physicians, patients and caregivers better access to precision medicine.
Our interdisciplinary approach empowers physicians with knowledge and insight about DNA drug sensitivity testing, helping them understand how their patient’s unique genetic profile affects the medications they prescribe.
Meet Our Staff
Cari A. Lalande, PharmD., RPh.
CEO | Clinical Genomic Pharmacist
Texas licensed clinical consultant pharmacist certified in pharmacogenomics focusing on patient-specific medication management through analysis of drug-gene interactions. My goal is to improve the quality of life for each patient by maximizing the efficacy of necessary drug therapy, eliminating polypharmacy and improving patient compliance.
Angie Ayers, PharmD, RPh.
Clinical Genomic Pharmacist
Angie graduated from Texas Tech Pharmacy school and has since had the pleasure of working in the retail, hospital, and the long-term care pharmacy settings. Additionally, she is certified in medication therapy management (MTM) and harmacogenomics (PGx).
Angie is blessed with 2 great children and a wonderful husband. In her “ spare” time, she shows ranch versatility horses out of her Stephenville, TX location.
How are Patients Tested?
A Certified Genomic Pharmacist takes a buccal swab from the inside of a patient’s cheek. The swab is then sent to Certified PGx Labs’ scientific team who uses an open array technology to identify 60 alleles present on 18 genes that determine if patients can metabolize the more than 200 medications checked.
What is Pharmacogenomics?
The human genome includes 3 billion nucleotide base pairs in the DNA that constitutes our 25,000 to 30,000 genes. The genes are responsible for coding of functional and structural proteins. A number are pharmacogenomics proteins—drug receptors, drug targets, drug metabolizing enzymes and drug transporters—important to accurate and effective medication therapy. These include, but aren’t limited to, the Cytochrome P450 enzymes—CYP2D6, CYP2C9, CYP2C19, CYP3A4/5, and others. Other proteins, such as VKORC1 and SLCO1B1 represent drug targets and transporters, respectively. These example proteins among others are critical in the application of pharmacogenomics in precision medicine. Variances in the activity of these enzymes may affect an individual’s pharmacokinetics (absorption, distribution, metabolism and excretion) as well as the pharmacodynamics (what effect the medication has on the body) of each medication the individual is taking. In the metabolism of drugs, an individual can be classified in one of five categories (metabolism phenotype) based on the activity of these pharmacogenomic proteins as defined by the Clinical Pharmacogenetics
Implementation Consortium (CPIC): Normal (formerly extensive metabolizer) (NM/EM) Fully functional enzyme activity. Intermediate metabolizer (IM) Decreased enzyme activity (activity between normal and poor metabolizer). Poor Metabolizer (PM) Little to no enzyme activity. Rapid Metabolizer (RM) Increased enzyme activity compared to normal metabolizers but less than ultra-rapid metabolizers. Ultrarapid Metabolizer (UM) Increased enzyme activity compared to rapid metabolizers. By considering an individual’s genetics relative to drug metabolizing enzymes, targets, receptors and transporters, healthcare providers can
now more precisely help patients to reach optimal drug therapy. Examples of drug-gene interactions for which pharmacogenomics can help optimize therapy:
Codeine – CYP2D6 Warfarin – CYP2C9 Clopidogrel – CYP2C19 Carbamazepine – HLA-B*15:02 Integrating Into Your Practice
The truth is that not every medication is safe and effective for
everyone. For the first time, PGx allows healthcare providers to look inside a patient – at their DNA – to gain insight as to how they will process and respond to medications, taking the much of the guesswork out of prescribing medications and improving patient outcomes. Through partnerships with Manchester University and PGx testing providers, RxGenomix is providing everything healthcare providers need
to integrate pharmacogenomics into their practice. RxGenomix is working closely with Manchester University to provide extensive education on the science while our testing partners are a sole-source provider of testing support.
Our team works directly with pharmacists and other healthcare providers to help them: Identify candidates for pharmacogenomic testing Collect and process the buccal swab sample Retrieve the results Collaborate with the prescribing physician on potential medication changes
PGx for Benefit Providers and Plans
Prescription drug spending in the U.S. is topping $360 billion per year. We already know failure rates for some classes of medications can be as high as 50–75%. If healthcare is your business, you can’t afford to be guessing anymore.
Pharmacogenomics (PGx) can provide healthcare providers unparalleled insight into how to prescribe the best medications at the right dosages, based on their unique genetics, and save you money in the process. Most medications on the market today were developed with population-level testing methods, but the result is often ineffective therapies and adverse drug reactions that generate more than 280,000 hospital admissions annually in the U.S. As a benefit provider, plan administrator, managed care organization or pharmacy benefit manager, integrating PGx into your current offering
could become the single most valuable tool you have to control costs and improve care for your membership.
RxGenomix can partner with you to turn claims data or health records into critical insights such as: Population-level financials Estimated return on investment Potential genetic risks Drug interaction risks Age-related toxicity issues
Anti-cholinergic burden Presence of FDA black box warnings
Lifestyle risksPregnancy/lactation risks
PGx for Employers
RxGenomix understands that an employer’s most important assets are their employees and the success of the company largely rests on the health of the individuals. No matter your industry, keeping your employees healthy and productive is a significant investment and navigating healthcare is a complicated and costly undertaking for even the most
sophisticated employers. Most are desperately searching for sustainable solutions that produce real value for both the organization, and their employees. That’s where pharmacogenomics (PGx) comes in. PGx testing can give healthcare providers unprecedented support in their clinical decision making when medication therapy is called for. More than 91% of people carry at least one actionable drug-gene mutation that could help the prescriber decide which medications will provide the best result, and at what dosages. And more effective therapies equal healthier employees. It’s that simple.
PGx for Physicians
According to a 2005 study in the New England Journal of Medicine, most major drugs are effective in only 25% – 60% of the population. We now know that many of these failures are entirely due to the performance of an individual’s drug-metabolizing enzymes, controlled by their genes. Healthcare providers have the ability like never before to improve outcomes while significantly reducing overall healthcare costs.
By working with RxGenomix, providers gain access to the information they need to make the best possible prescribing decisions for each patient, based on their unique genetics. And by combining pharmacogenomic testing with the input of a pharmacist trained in pharmacogenomics, prescribers can create a truly personalized medication plan for each patient. This
will: Allow prescribing of optimal medications and with much greater speed Reduce serious or even fatal adverse drug events Improve patient outcomes Reduce medication usage Reduce overall medical expenses
PGx testing is a reliable predictive test for pharmacotherapy and, with total annual prescription drug spending nearing $400 billion in the U.S., we simply can’t afford to be guessing anymore.
Integrating PGx into Pharmacy Practice
Pharmacists are the medication
experts in the healthcare spectrum and the primary goal of RxGenomix is to make sure they are empowered to lead the way in the integration of pharmacogenomics (PGx) into patient care. Any pharmacist in any area of
clinical practice can apply PGx to patient care and RxGenomix can show you how.
The first step for enabling pharmacists to lead is through formal education on the science and application of pharmacogenomics through the RxGenomix Training Program in Pharmacogenomics. This 16-hour course,
offered jointly by RxGenomix and the American Pharmacists Association, provides a solid basis for applying the science to individual patient care.
Our second goal is to change the pattern of PGx implementation. Physicians and labs have tried for several years to integrate PGx into practice with very limited success. By educating and involving the
pharmacist in the PGx testing process, a trained expert can give prescribers invaluable guidance on how to apply the results of testing directly to patient care.