In the ever-evolving landscape of clinical pharmacogenomics, driving sustainable PGx sample volume is both challenging and rewarding. Dr. Becky Winslow, founder and principal at inGENEious RX Inc. and a leading expert in the field, recently shared her insights in a webinar that delved into the intricacies of this topic to explore: what are effective strategies to increase pharmacogenomics (PGx) sample volume in clinical settings?
In this article, we summarize the top five approaches to strategizing for sustainable PGx sample volume, based on Dr. Winslow’s presentation.
1. Advanced Market Segmentation
Market segmentation is akin to a game of chess, where success depends on strategic moves rather than broad strokes. Dr. Winslow explained that segmentation involves dividing a broad target market into smaller, more specific groups based on shared characteristics, needs, behaviors, or demographics. This approach allows labs to tailor their products, services, and marketing strategies to responsive and profitable segments.
Key Highlights:
- Identify High-Value Targets: Focus on payer policies to determine which gene-drug pairs are eligible for reimbursement.
- Tailor Offerings: Align test panels with payer expectations to help ensure coverage and reimbursement.
- Segment by Clinical Setting: Determine where clinicians routinely prescribe the drugs for intended uses (e.g., inpatient vs. outpatient settings).
2. Strategic Market Penetration
Once the market is segmented, the next step is penetration—entering and expanding within the defined market segments. Dr. Winslow likened this to advancing pieces across a chessboard, where each move must be calculated and purposeful.
Key Highlights:
- Educate Healthcare Professionals: Provide targeted education about PGx, its intended uses, and clinical applications.
- Support Clinical Implementation: Offer logistical support such as easy test ordering and result retrieval.
- Build Trust and Adoption: Align with payer policies and embed PGx into routine clinical workflows.
3. Leveraging Payer Policies
Understanding payer policies is crucial for identifying high-opportunity targets for test utilization, reimbursement, and clinical integration. Dr. Winslow provided a detailed analysis of payer coverage patterns, highlighting the differences between commercial insurers, Medicaid, Medicare, and cash payers.
Key Highlights:
- Commercial Insurers: Often have limited coverage and require rigorous documentation and prior authorization.
- Medicaid: Coverage is inconsistent and state-specific, often requiring additional steps such as genetic counseling.
- Medicare: Coverage is managed by Medicare Administrative Contractors (MACs) and hinges on national and local coverage determinations.
- Cash Payers: Represents flexible reimbursement environments.
4. Targeting High-Value Clinical Settings
Identifying and targeting clinical settings with high concentrations of patients consuming covered medications is important for capturing more samples. Dr. Winslow emphasized the importance of understanding whether physicians typically prescribe medications in inpatient or outpatient settings.
Key Highlights:
- Inpatient vs. Outpatient: Reimbursement for PGx testing differs substantially between these settings due to variations in billing models and payer policies.
- High-Volume Settings: Focus on settings like long-term care facilities, primary care practices, and behavioral health clinics where multiple diseases are treated with multiple medications.
5. Engaging Key Prescribers
The adoption of PGx testing among healthcare professionals varies, and targeting the right prescribers is crucial for driving sample volume. Dr. Winslow discussed the current landscape of PGx adoption among different provider groups.
Key Highlights:
- Nurse Practitioners: High adoption rate due to prescribing autonomy and strong representation in primary care and behavioral health.
- Pharmacists: Leaders in medication therapy management with deep expertise in drug-gene interactions.
- Physician Assistants: Moderate to high adoption driven by team-based care models.
- Physicians: Adoption varies significantly, with specialists like psychiatrists and oncologists more likely to utilize PGx testing.
The Path to Sustainable PGx Testing
Dr. Winslow’s webinar underscored the importance of strategic market segmentation and deliberate penetration in driving sustainable PGx sample volume. By understanding payer dynamics, clinical contexts, and prescriber behavior, labs can aim to convert interest into action and scale their testing programs effectively.
Access educational resources at thermofisher.com/pgxeducation.