When the Human Genome Project was completed in April 2003, an ability to sequence and map genes made it possible to “read nature’s complete genetic blueprint for building a human being,” according to government researchers.
Fast forward to the present and nearly 60% of 200 employee benefit executives and brokers polled by startup Wamberg Genomic Advisors (WGA) believe genomic products are a good benefit to offer employees. Moreover, 62% of respondents said they’d personally want to get their own genetics tested as long as their privacy was maintained.
“The most promising avenues for widespread delivery of genomic testing are employee benefit programs and life insurance policies,” according to Tom Wamberg, CEO of WGA. His firm helps employers, benefit brokers and life insurance companies create programs that provide employees and policyholders with easy access to affordable genomic tests.
The power of genomic testing, which is much broader than genetic testing, is that it can help employees determine whether they have a high genetic propensity for developing Alzheimer’s, Tay-Sachs, cystic fibrosis or a host of other diseases and conditions.
Genomics examines the structure and function of genomes, whereas genetics focuses on the variation and function of single or limited numbers of genes within a genome. While genetics can help determine health status or risk for certain diseases or conditions, genomics can lead to a deeper understanding that results in more effective preventive measures or treatments.
WGA’s initial focus will be on whole genome sequencing and reporting, exome sequencing and reporting, cancer genomic profiling, cancer liquid biopsy, lifetime stem cell banking and lifetime connectivity to one’s DNA.
Benefit adviser Anthony J. Domino, Jr., managing director of Associated Benefit Consultants, LLC, considers genomic testing “another arrow in my quiver for our clients. I think it’s a great differentiator and value creator. It’s something that allows us to change the tenor and note of the [healthcare] conversation.”
The fact is that a host of services, particularly in the employee benefits space, are crowded and marginalized, he says. “There’s a real race to the bottom, where everyone thinks it’s all about fees. And fees are important, but so are value and creativity and context, as well as content. So I find that the genomic testing program offers tremendous value within the marketplace.”
His firm is rolling out WGA’s program only to help solidify existing client relations. Domino would rather wait “until it’s more well-known and generally accepted” before using the benefit to help lure in new clients.
There are a range of genomic testing packages starting with a basic $100 test known as “23andMe” that examines a tiny part of the genome but doesn’t include enough information to be predictive about healthcare. Wamberg says it can be offered as a voluntary benefit to lower-wage earners who can use pretax dollars from their flexible spending account or health savings account.
The most comprehensive and expensive test at about $2,000 is a whole genome sequence, which maps all of an individual’s DNA. Along with an exome test that costs roughly $1,000 and is somewhere in the middle in terms of the data it produces, it could be offered as an executive benefit that an employer pays for to help lure top talent.
Managing Rx costs
In addition, a $700 pharmacogenomics test, which as the name suggests combines pharmacy and the genome, can determine which drugs work best for each individual based on his or her genetic profile. It involves customized or precision medicine, which Wamberg says can show how fast or slow one’s body metabolizes, and can help reduce polypharmacy claims involving five or more prescription drugs for a single individual.
“By having their employees tested, we can make sure that the drugs they’re getting are the right drugs and at the right dosage, which we believe has a very quick ROI for the employer,” he explains. “The sooner they get their employees sequenced, the better.”
With specialty drug costs soaring in recent years and expected to climb even higher, this approach could have enormous appeal across the industry as employers seek to bend the Rx cost curve in consultation with their brokers, advisers and pharmacy benefit managers.
“It’s a huge area of interest for us, and I think a terribly important area for medicine to get more and more effective for patients,” observes Surya Singh, M.D., vice president and chief medical officer, specialty pharmacy at CVS Health.
One challenge with genomic and genetic testing, of course, is to allay privacy concerns. “There’s certainly employee suspicion that people would take these tests and you’d get denied a promotion, or other bad things would happen,” Wamberg acknowledges.
“But if the employer had this data and used it for any of those Machiavellian reasons, it would be a pretty easy case for a lawyer,” he continues. “So our experience is employers don’t want the data. They’re not going to put it in the employee’s file. They’re not going to penalize them or reward them based on how well they do on the pharmacy spend. What they just want to be is they want to be a conduit to get these tests into the employees’ hands and get the utility and the efficacy from them, without building some massive database they manipulate from time to time.”
As the cost of genomic tests continues to decline, Wamberg believes they will be more affordable for average employees. He says another bright spot is that the efficacy of the science is expected to improve, which could produce better results.
Domino has little doubt that in time genomic benefits will be “less the exception and more the rule. Whereas I may be one of 50 or 100 brokers in a community talking about it now, if I’m one of 10, that’s probably not a bad thing, and hopefully my role and awareness will still keep me elevated among the fray.”
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