Pharmacogenomics for Mental Illness Delivers Strong Results

CEO of Personalized Prescribing speaks out on benefits of service for employees, plan sponsors, and insurers

Pharmacogenomics for Mental Illness Delivers Strong Results

“Personalized Prescribing focuses on pharmacogenomic testing for mental illnesses,” says Mark Faiz, founder and CEO.

In an Up Close interview with Benefits and Pensions Monitor, he said “We focus on mental illness for two reasons.

“First, mental illness medication is the most challenging medication and is on par with cancer medication as the brain is the most complex organ in the human body. It is a fact that mental illness medication fails more than 50 per cent of the time and it can take weeks to take effect.”

“The other reason is the need for mental illness solutions in the Canadian workplace. We passionately assert that pharmacogenomics for mental illness medication could be a game-changer for mental wellbeing in the Canadian workplace. So mental illness cries out for pharmacogenomics.”

How are you different from your competitors?

Faiz: I will start with some history; the first pharmacogenomics tests were simply a listing of the highest-level evidence of a gene versus a drug as listed by the Pharmacogenetic Knowledge Base (PharmGKB). Most pharmacogenomics companies simply tested for the listed genes and used software to deliver the information on PharmGKB.

We were one of the companies doing just that from 2015 to 2017. Our practice from that period taught us two things: most patients who came forward were ones suffering with mental illness, and we were told that most patients reported that the test was not helpful.

In fact, CAMH had conducted a large trial from 2015 – 2020 using the simple list above with a couple of brain receptors added. Its results showed that pharmacogenomics at that time were not significantly better than the usual treatments.

There was an enormous amount of scientific evidence on single genes versus antidepressants, but there was also much contradiction.

In 2015 and 2016, the leading scientists in pharmacogenomics concluded that a single gene versus drug approach would not work for brain medication. Instead, they suggested a polygenetic approach. In 2018, we decided to shift to a polygenetic approach, while our competitors continue to use the single gene tests. We also recognized that our team needed pharmacists to better understand the drugs’ mechanism of action as we developed our new polygenetic approach.

We conducted our own research. Our team investigated all the brain receptors that are implicated in antidepressants’ mechanism of action. We mapped out the receptors and their different variants’ expressions. We developed a new test containing the highest-level evidence genes related to antidepressants, but also added brain receptors that we identified as mechanistically relevant for antidepressants.

Our algorithms followed a streamlined approach and addressed the following:

  • Clearance capacity ‒ dose adjustment requirement. Most of our competitors do this effectively, but that is all they do!
  • Blood brain barrier entry genes (anti-depressant efflux risk)
  • All antidepressant drugs target receptor genetic expression and function
  • Other relevant brain receptor genes

We began to use the new test with our in-house developed algorithms in 2018 and the results were very good.

However, we did not rest. We continued our research and we followed up with our patients. From that data analysis we learned even more. We have just designed our third iteration of our test which will include many more brain receptors.

We learned that to serve our clients properly, we needed pharmacists to interact and assess patient’s anamnesis, then interpret their results while considering patients’ other medical conditions and prescriptions that may impact antidepressant response and support them with side effects management along the way.

We are now getting excellent results as evidenced by our Google reviews and Manulife published results.

When deciding on a pharmacogenomics supplier, what, in your opinion, should insurance carriers / employers consider?

Faiz: They must do their homework in at least a few areas; they must understand the science and choose services that have produced results. They cannot evaluate services based on glamour or glitz, but substantive science. In its due diligence to select Personalized Prescribing as its provider, Manulife engaged its pharmacists in evaluating suppliers.

This evaluation should be very exhaustive and include consideration of security of systems and lab certification as well as the other usual standards in vendor evaluation.

What, in your opinion, is the best fit for pharmacogenomics in the workplace?

Faiz: Undoubtedly, our services are necessary for employees on disability due to mental illness. However, we believe that the best use of pharmacogenomics in the workplace is by embedding it within the health plan. Using pharmacogenomics within a health plan would boost productivity, reduce absenteeism, and may well prevent some disability from ever developing.

Recent science has confirmed that depressed people that go without effective treatment develop into ‘Severe Depression’ and, with that, a serious loss of neurons and neuronal connectivity within their brain. That means that when they do get the right treatment, they would need years of successful treatment to rebuild their lost neurons and neuronal connectivity. Pharmacogenomics can help employees avoid ever getting to severe depression.

Why are other insurance carriers not clamouring for your services?

Faiz: Manulife is not the only insurer, we do have a few others, but frankly others, I suspect, suffer from apathy or lack of understanding that pharmacogenomics tests are not all the same. This is the time that every insurance company ought to seriously dig into pharmacogenomics and identify the ser- vices that will help their plan sponsors and their employees.

Can employers work with you directly?

Faiz: Absolutely, employers have the most to lose from their employees’ untreated mental illness. They already spend significant sums on mental illness treatment and avoidance. They ought to do their homework to identify the best pharmacogenomics service that will help their employees.

Can you discuss your relationship with Manulife?

Faiz: Pharmacogenomics for mental illness is now delivering strong results for Manulife, they took the time to investigate the legitimacy and effectiveness of pharmacogenomics in psychotropic medication for use in the workplace. Their objective was to investigate if pharmacogenomics can help with disability due to mental illness. They also hoped to investigate the impact of pharmacogenomics on the ‘At-Work’ population from a presenteeism and absenteeism perspective.

After assessing a few suppliers, they settled on Personalized Prescribing Inc. for the Manulife Personalized Medicine Program. The program was launched on March 1, 2021, for disability management, and later they included pharmacogenomics within its employees’ health benefit package, effective May 1, 2021.

In July 2022, Manulife published the results from one year’s experience in both disability management and how impactful the inclusion of pharmacogenomics was on their employees’ benefit plan.

In Manulife’s words for disability, “In a case study with a plan sponsor, we saw a 17 per cent reduction in short-term disability duration in members that had a test, compared to a matched group of members who did not have a test.”

By embedding pharmacogenomics in a health plan, Manulife estimates organizations can save about $2,400 in direct and indirect health costs when a member making $30 per hour optimizes their medication therapy in the program. Testing has the potential for a 6:1 return on investment based on the success it has seen with its personalized medicine program and research.