Major Gains in Physician Use of Genetic Tests Reported in New Study

Nationwide program proves choice, easy access to information and genetic tests overcome barriers to adoption of pharmacogenomic testing

WASHINGTON, Nov. 8, 2010 /PRNewswire-FirstCall/ -- While the vast majority of physicians recognize the contribution of genetic tests for improving medication response by guiding the prescribing and dosing of many widely-used medications, most doctors don't feel they know enough about these tests to put them into practice.  However, new data from the Medco Research Institute™ -- a research subsidiary of Medco Health Solutions, Inc. (NYSE: MHS) -- shows that when both physicians and patients are informed about choices regarding testing and the process is made convenient, the adoption of genetic tests is substantially increased - an advance that can lead to safer and more effective use of medications.  The new data were presented this past weekend at the Annual Meeting of the American Society for Human Genetics.

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The use of genetic testing in patients on the blood thinner warfarin and the breast cancer prevention drug tamoxifen has been low in routine practice.  But according to the analysis, when a proactive pharmacy-based pharmacogenomic testing program was implemented, the incidence of testing in patients on warfarin was nearly 45-times higher, and was nearly 7-times higher among patients on tamoxifen as compared to the pre-program time period.

"It's quite remarkable that we saw such a huge jump in the adoption of genetic testing following the proactive outreach to physicians and patients to inform them about the availability of the tests," said Eric Stanek, PharmD, Medco's senior director of personalized medicine research and the study's lead researcher.  "It shows quite convincingly that physicians and patients can understand the value of these tests when choice, information, genetic testing, and results reporting are made accessible and convenient.  This is a very important step in establishing a model that can substantially move the genetic testing needle forward and expedite its adoption in routine clinical care on a broad scale."  

The testing program identified appropriate patients for testing, engaged physicians and patients about the genetic tests and gained their consent for testing, coordinated the collection of DNA samples from patients and their shipment to a qualified laboratory, and communicated test results and interpretation of those results to physicians.  The full cost of the service and genetic tests were covered by the patients' prescription drug benefit plan.

The analysis found that when genetic testing was considered potentially appropriate, physicians gave their consent for testing in 49 percent of their patients using warfarin, and for 54 percent of their patients using tamoxifen.  Additionally, the nationwide program led to patient consent for testing in 39 percent of patients on warfarin and 56 percent of patients using tamoxifen, among those considered potentially appropriate for testing.  

"This analysis was conducted early on in the pharmacogenomics testing program; since then the number of patients enrolled in the program has substantially increased and it appears the consent rate for testing has risen even further over that time which is extremely encouraging," said Stanek.  

More details about the analysis and its results can be found at www.medcoresearchinstitute.com

The two medications that were the focus of the study are both impacted by gene variants that can significantly affect a patient's response to the drug.  For warfarin, genetic testing can help physicians determine the proper dosage for an individual patient sooner than traditional methods, thus reducing the risk of a serious bleed or blood clot; for tamoxifen, a genetic test can help predict whether the drug will work in preventing the recurrence of breast cancer in an individual patient.

Warfarin

Warfarin (branded as Coumadin® and Jantoven®) is a commonly used blood thinner that can be difficult to properly dose because patients have widely varying responses to the medication due in part to their genetic make-up; too high a dose can cause bleeding and too low a dose can result in blood clots. Warfarin is the leading cause of drug-related emergency room visits among the elderly and up to 20 percent or more of patients are hospitalized for bleeding within six months of starting on the drug.  Because of these risks, the FDA added information to the drug label for dosing recommendations based on genetic tests results.  Providing patients genetic tests to help physicians more precisely prescribe the correct dose of warfarin decreased hospitalization rates by approximately 30 percent according to a study by the Medco Research Institute and Mayo Clinic that was recently published in the Journal of the American College of Cardiology.  

Tamoxifen

Tamoxifen is one of the oldest and most widely used treatments for reducing the risk of breast cancer recurrence among women with estrogen-dependent tumors.  Approximately 500,000 women take tamoxifen in the U.S., with 80,000 new patients starting on the treatment annually.  Approximately 10 percent of women using tamoxifen do not fully benefit from the drug because they have a genetic variant that inhibits an enzyme needed to activate the medication.    

Medco's Personalized Medicine Program

In its ongoing effort to improve patient safety and lower healthcare costs, Medco established a personalized medicine program that offers pharmacogenomic testing for a number of medications, including warfarin, tamoxifen, Plavix® (clopidogrel), certain HIV drugs and drugs for treating chronic myelogenous leukemia.  As part of the program, Medco analyzes prescription claims histories to identify patients who could benefit from genetic testing, communicates with physicians about testing options and results, facilitates patient testing with national laboratory partners and engages patients to educate them about genetic tests.

About Medco Research Institute

Medco Research Institute™ is an evidence-based research organization focused solely on novel research, analytics and new discoveries that close the gap between scientific discovery and medical practice for improved patient outcomes and lower overall healthcare costs. More information about the Medco Research Institute's peer-reviewed research can be found at www.medcoresearchinstitute.com.

About Medco

Medco Health Solutions, Inc. (NYSE: MHS) is pioneering the world's most advanced pharmacy® and its clinical research and innovations are part of Medco making medicine smarter™ for approximately 65 million members.

With more than 20,000 employees dedicated to improving patient health and reducing costs for a wide range of public and private sector clients, and 2009 revenues of nearly $60 billion, Medco ranks 35th on the Fortune 500 list and is named among the world's most innovative, most admired and most trustworthy companies. For more information, go to http://www.medcohealth.com.

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company's Annual Report on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commission.

SOURCE Medco Health Solutions, Inc.

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