Combinatorial pharmacogenomic guidance for psychiatric medications reduces overall pharmacy costs in a 1 year prospective evaluation

Curr Med Res Opin. 2015;31(9):1633-43. doi: 10.1185/03007995.2015.1063483. Epub 2015 Jul 23.


Objectives: The objective of this project was to determine pharmacy cost savings and improvement in adherence based on a combinatorial pharmacogenomic test (CPGx ) in patients who had switched or added a new psychiatric medication after having failed monotherapy for their psychiatric disorder.

Research design and methods: The prospective project compared 1 year pharmacy claims between a GeneSight CPGx guided cohort and a propensity-matched control group. Patients were project eligible if they augmented or switched to a different antidepressant or antipsychotic medication within the previous 90 days. Following the medication switch or augmentation, pharmacogenomic (PGx) testing was offered to each patient's treating clinician. Pharmacy claims were extracted from the Medco pharmacy claims database for each patient (n = 2168) for 1 year following testing and compared to a 5-to-1 propensity-matched treatment as usual (TAU), standard of care control group (n = 10,880).

Main outcome measures: Total pharmacy spend per member per year; adherence.

Results: Patients who received PGx testing saved $1035.60 in total medication costs (both CNS and non-CNS medications) over 1 year compared to the non-tested standard of care cohort (p = 0.007). PGx testing improved adherence compared to standard of care (ΔPDCCPGx = 0.11 vs ΔPDCTAU = -0.01; p < 0.0001). Pharmacy cost savings averaged $2774.53 for patients who were changed to a CPGx congruent medication regimen, compared to those who were not (p < 0.0001).

Conclusions: PGx testing provides significant 'real world' cost savings, while simultaneously improving adherence in a difficult to treat psychiatric population. Limitations of this study include the lack of therapeutic efficacy follow-up data and possible confounding due to matching only on demographic and psychiatric variables.

Keywords: Adherence; Combinatorial pharmacogenomic testing; Mental health; Pharmacogenomics; Pharmacy spend.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antidepressive Agents* / economics
  • Antidepressive Agents* / therapeutic use
  • Antipsychotic Agents* / economics
  • Antipsychotic Agents* / therapeutic use
  • Cost Savings / statistics & numerical data
  • Drug Costs / statistics & numerical data
  • Fees, Pharmaceutical / statistics & numerical data
  • Female
  • Genetic Testing / economics*
  • Genetic Testing / methods
  • Humans
  • Male
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data
  • Mental Disorders / drug therapy
  • Mental Disorders / psychology
  • Middle Aged
  • Outcome Assessment, Health Care
  • Pharmacogenetics* / economics
  • Pharmacogenetics* / methods
  • Prospective Studies
  • United States


  • Antidepressive Agents
  • Antipsychotic Agents