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Pharmacogenomics in the Community Pharmacy

It's no secret that pharmacies are going to have to diversify their revenue streams and continue to expand on non-dispensing revenue in order to survive. This can take many forms, including boosting front-end sales, adding new services like MTM and chronic care management, and more recently pharmacogenomics.


Want some more ideas? Check out 100+ ways to make your pharmacy better.


With pharmacogenomics being so new, it can be hard to even know how to get started, where it fits in with your existing business model, and where to learn more on the subject.


In the spirit of PharmCompliance, this article won't be discussing the clinical details of pharmacogenomics, but rather how to operationalize and build your genomics business.


OK let's get started!


Where do I learn the clinical side of pharmacogenomics?


Thankfully, pharmacy schools and professional organizations have stepped in and started offering a lot of education in this area. Most people probably got little to no education in genomics in school (I only remember them droning on about VKORC1), so if you decide to get in the business you'll need to get up to speed.


Here are a few to get you started in your search:


University of Florida

University of Colorado-Denver

NACDS

ASHP

Mayo Clinic

Shenandoah University

RxGenomics

ACCP


I'm not advocating one over the other, so do your homework.


OK that's about all I'll say on the clinical side. Now on to how to make it happen, and more importantly, how to grow your business with the service.


Do I need a lab or expensive equipment for this?


Absolutely not. Patients will typically have a genomics test ordered by their provider, and will then go to a commercial lab to have it done. Both Quest Diagnostics and LabCorp are in this business. They then send the results back to the provider's office, just like they would any other test.


Should everyone get tested?


It's not really cost-effective to test everyone, because there are going to be many patients on just a few meds that have not had any genes identified that affect response. Because of this, you're going to need an efficient way to screen patients that might benefit from the service.


There are actually genomics software platforms that integrate with your pharmacy dispensing system to help you risk-stratify and determine who will benefit the most from the service. Examples include Rxight and MedTek21.



How can I make money doing this?


Now for the million-dollar question (OK it's probably not that much). The bad news is, most insurance companies are not currently going to pay for the service.


HOWEVER


That isn't a reason not to launch the business. After all, if you can get patients who are willing to pay cash to have it done, is that not better than dealing with billing?


Here is how you can do it, in a few broad categories:

  1. Work with a provider's office

  2. Contracting directly with a facility or company

  3. Hiring a provider or provider service

Now let's break each of these down:


1. Working with a provider's office


Billing for Chronic Care Management (CCM)


Regardless, with providers being the ones to order the test, you'll need to develop a good relationship with a provider. However, this relationship can go deeper to allow pharmacists to actually bill for their services under the provider. This is done using specific CPT codes for Chronic Care Management. You can take a look at the guide here.