Implementation of a pharmacogenomics service in a community pharmacy

Objective: To determine the feasibility of implementing a pharmacogenomics service in a community pharmacy. Setting: A single community pharmacy that is part of a regional chain known for offering innovative pharmacy services. Practice description: Community pharmacists at the project site routinely provide clinical pharmacy services, including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. Practice innovation: The implementation of a pharmacogenomic testing and interpretation service for the liver isoenzyme cytochrome P450 2C19. Participants: 18 patients taking clopidogrel, a drug metabolized by CYP2C19. Main outcome measures: Rate of patient participation, rate of prescriber acceptance of pharmacist recommendation, time to perform genetic testing service, and number of claims submitted to and paid by insurance. Results: Of 41 patients taking clopidogrel and meeting project criteria, 18 (43.9%) enrolled and completed testing and interpretation of pharmacogenomic results. The mean time pharmacists spent completing all stages of the project with each participant was 76.6 minutes. The mean time to complete participation in the project (time between person's first and second visit) was 30.1 days. Nine patients had wild-type alleles, and pharmacists recommended continuation of therapy as ordered. Genetic variants were found in the other nine patients, and all pharmacist recommendations for modifications in therapy were ultimately accepted by prescribers. Overall, 17 patients consented to filing of reimbursement claims with their insurers. Five were not able to be billed due to submission difficulties. Of the remaining 12, none was paid. Conclusion: A pharmacogenomics service can be an extension of medication therapy management services in a community pharmacy. Prescribers are receptive to having community pharmacists conduct pharmacogenomics testing, but reimbursement is a challenge.