Expand DNA Testing to Improve Precision MAT/MAR Therapies

Introductory Paragraph

Genetics and genetic makeup impact how individuals respond to medications. With today's more refined analysis of the human genome map, there is a growing understanding of how DNA accounts for changes in drug metabolism. This means that DNA testing can enhance personalized medicine to improve Medication-Assisted Therapy (MAT).

Key Information

"Precision medicine focuses on providing health care with increased resolution, accounting for aspects that are unique to the individual and their disease. By definition, precision medicine involves all phases of care: prevention, diagnosis, and treatment."

The Opportunity with Precision MAT

With today's more refined analysis of the human genome map, their is a growing database of variability of gene alleles and how they account for changes in drug metabolism. A clinical genomic test can be performed and a report can be created that displays the expected benefits and risks the patient has if they receive any one of over 200 medications (in this case with a focus on the drugs being used to treat opioid addiction), and how the patient's dietary regimen can affect medications they may be taking or will take in the future to treat their addiction and potential related diseases.

• Such dynamic, interactive reports can then be used by physicians and other medical providers such as nurse practitioners, pharmacists, therapists, dietitians and other social service professionals to develop more precise treatment plans of care for the individual patient.
• An on-going research study is showing that more precise dosing in Medication Assisted Treatment, based on more accurate analysis of Gene allele variability| has decreased relapse rates in opioid addicted patients down to 25% over an 18 month tracking period.

Genetic Tests

• A genetic test is performed by obtaining a simple cheek swab that collects DNA from the cells on the inside of a person’s mouth. The specimen collection can be performed by an appropriately trained individual and the report results available in 1-2 weeks.
• Using a cheek swab is one of the two most popular ways to do DNA tests .
• Insurance coverage varies for this test which costs approximates between $500 and $1,200 based on whether annual pharmacy consultative services are included.
• Medicare is the most reliable payer and the commercial carriers range in reliability of payment. Few Medicaid carriers are currently paying for these tests today but with the significant funding being made available to individual states to address the opioid addiction crisis, the anticipation is that the state based Medicaid plans will begin to address this coverage gap.
• Premier DNA is a genetics testing company that has created a integrated care model combining genetic testing, interactive genetic reporting, and pharmacy consultation. They offer this program under the registered trade name Med Op Rx. This service becomes a useful tool to guide the physician in terms of implementing the most precise MAT program given the individual patient's genetic makeup.

Relevant Research

There is ongoing research and funding around precision medicine across both mental and physical health including substance use and medication assisted therapy.

Genetic testing: Opportunities to unlock value in precision medicine

Pharmacogenetic Testing: A Tool for Personalized Drug Therapy Optimization

U.S. Department of Veteran Affairs Office of Research & Development Genomics & Mental Health

Biomarkers in precision medicine for mental illnesses

Precision Medicine & Global Mental Health

Study design and implementation of the Precision Medicine In Mental health Care (PRIME Care) Trial

An on-going research study is showing that more precise dosing in Medication Assisted Treatment, based on more accurate analysis of Gene allele variability| has decreased relapse rates in opioid addicted patients down to 25% over an 18 month tracking period.

Impactful Federal, State, and Local Policies

Precision Medicine Initiative 2015/2016 White House initiative to improve precision medicine. The mission is to enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care.

Personalized Medicine Coalition PMC engages on a number of key priorities in public and science policy to advance its mission. of promoting innovation and delivery of cell and gene therapies.

Department of Health and Human Services Grants Development of Psychosocial Therapeutic and Preventive Interventions for Mental Disorders (R61/R33)

Available Tools and Resources

Genetic Testing and Precision Medicine- A personalized medical approach to improve outcomes.

Personalized Medicine Coalition- Personalized Medicine Report

Therapeutic drug monitoring: A patient management tool for precision medicine

Therapeutic drug monitoring in the era of precision medicine

Promising Practices

Precision Medicine's value - Includes promising practices and developments in the field of precision medicine and therapies.

---