The Right Drug the First Time: What Pharmacogenomics Could Mean for Your Health Plan

Finding the right prescription shouldn’t be a guessing game.

Every medication change, adverse reaction, and ineffective prescription can lead to more doctor’s visits, hospitalizations, and higher healthcare costs. For employers already grappling with rising costs, these factors can add up quickly. Pharmacogenomic (PGx) testing offers a way to make prescriptions more precise from the start, making care more effective and lowering costs.

Before diving into the details of how PGx works, let’s take a step back and talk about what it is. PGx testing acts as a cheat sheet to an individual’s DNA. It looks at how genes influence the way a person processes medications, indicating what prescriptions can be broken down quickly, which are ineffective, and even which ones may cause harm. Instead of prescribing by trial-and-error (or let’s be honest, a bit of educated guesswork), providers get a genetic head start on finding out what actually works for their patients. That means fewer medication switches, fewer adverse reactions, and an improved experience for patients¹ .

Research suggests this approach makes a noticeable difference for patients. A study published in the Journal of Occupational and Environmental Medicine found that nearly 86% of more than 400 patients received actionable medication recommendations after testing². This included changing medications, adjusting dosages, discontinuing ineffective therapies, and increasing monitoring for potential side effects.

These improvements can also translate into healthcare savings. The American Journal of Managed Care published a study that found PGx testing increases the likelihood that patients receive the right medication and dosage earlier in treatment³. Even after accounting for the cost of testing, the study found an average annual savings of almost $4,000 per patient⁴. This was driven by fewer hospitalizations and emergency department visits, reducing delays in treatment, and lowering other healthcare costs.

As awareness around PGx testing grows, so does employer and employee interest. Bolton recently launched two pilot programs and has seen encouraging early engagement. One pilot, designed for 100 participants, enrolled more than 140 employees. Another filled all 50 spots within a week. Outcome reporting is still underway, but strong participation indicates employees are interested in personalized pharmacy benefits that can curb broader adverse health outcomes.

As personalization sweeps everything from grocery shopping to advertising, shouldn’t prescription drugs lead the way? Employers that proactively evaluate emerging strategies like PGx testing may be better positioned to improve healthcare and reduce unnecessary spending. Ultimately, the goal shouldn’t be just to lower costs. It should be to help employees receive the right medication the first time.

[1] Early Insights From a Pharmacogenomic-Enriched Comprehensive Medication Management Program Implementation in an Adult Employee Population – PMC

[2] Pharmacogenomics for Improved Outcomes and Decreased Costs in Health Care | AJMC

[3] Pharmacogenomics for Improved Outcomes and Decreased Costs in Health Care | AJMC

[4] Pharmacogenomics for Improved Outcomes and Decreased Costs in Health Care | AJMC