10. Pharmacogenomics at the prescription
Clinicians with complex patients; providers of specialized services Planned episode, genetics in practice. When a pharmacogenomic result is worth ordering, and how it reaches the prescribing decision.
Listener title: Pharmacogenomics at the prescription: ordering, storing, paying
Listener description: A clinical pharmacist talks through when a pharmacogenomic result is worth ordering and how it reaches the prescribing decision. The episode covers prescriptions changed because of a result, where results should live so the next prescriber sees them, and how cost and payment are discussed with patients. For prescribing clinicians and for providers who offer pharmacogenomic testing or consultation.
Run of show (about 40 minutes)
| Time | Segment | What happens |
|---|---|---|
| 0:00 to 2:00 | Opening | The host introduces the topic and the guest's role. The guest discloses any industry relationships. The host notes that no patient information is discussed and that the guest speaks for themselves, not for the network. |
| 2:00 to 11:00 | Prescriptions changed by a result | Which prescriptions has the guest actually changed because of a result, and what made the result decisive? The guest explains how they use the CPIC guidelines, and how they read the differences among professional society recommendations about when to test (Hertz 2024). Where has a result made no difference? |
| 11:00 to 19:00 | When a result is worth ordering | How does the guest decide between a single-gene test at the time of a prescription and a preemptive panel? The guest explains what a preemptive testing program (Van Driest 2014) and the PREPARE trial (Swen 2023) do and do not show for a primary care or specialty practice, what the fourth journal club reading (El Rouby 2025) says about adoption in primary care, and what they check on a laboratory's panel before recommending it. |
| 19:00 to 27:00 | Where the result lives | Where does a result live so it is seen at the next prescription, including by a prescriber outside the practice? The guest explains the CPIC standard terms for results (Caudle 2017), whether results belong on the problem list or as drug alerts, and how they account for other medicines that change how a gene behaves. |
| 27:00 to 33:00 | Composite scenario, not a real patient | The host states that this is a composite scenario, not a real patient. A patient had a pharmacogenomic panel several years ago through another practice; the report is a scanned document in the chart that no one has opened. An outside specialist now starts a new medication. The host and guest discuss who should catch it, what the primary care clinician does on finding the result, and what changes in the practice afterward. |
| 33:00 to 37:00 | What it costs, and who pays | Discussed as method, never as what anyone should charge. What drives the cost of a single-gene test compared with a panel, and of the interpretation visit? How does the guest explain coverage and out-of-pocket cost to a patient before ordering? |
| 37:00 to 40:00 | Closing | One practical takeaway: store each gene's result where the next prescriber will see it, in the standard terms the network's pharmacogenomic profile care map uses, on the problem list or as a drug alert. To reach the network, email hello@coloradocarenetwork.com or visit coloradocarenetwork.com/join. To suggest an episode, send the question in two sentences to the same address; members can also post it in #podcast on Slack. |
Guest prep questions (sent to the guest a week ahead)
- Which prescriptions have you changed because of a pharmacogenomic result, and what made the result decisive?
- How do you decide between a single-gene test and a preemptive panel?
- What do you check on a laboratory report or panel before you rely on it for prescribing?
- Where should results be stored so the next prescriber, including one outside the practice, sees them, and how do you account for interacting medicines?
- How do you explain cost and coverage to a patient before testing, as method rather than a price?
Show notes
This episode asks when a pharmacogenomic result is worth ordering and how it reaches the prescribing decision. A clinical pharmacist describes prescriptions changed because of a result, how they choose between single-gene and preemptive panel testing, and where results should be stored so the next prescriber sees them. The discussion refers to the implementation studies and CPIC standard terms cited on the network's pharmacogenomic profile care map, and to the fourth journal club reading. Cost and payment are discussed as method, never as what anyone should charge.
- Sources:
- El Rouby N, Johnson JA. NEJM Evidence 2025. doi:10.1056/EVIDra2400343
- Hertz DL, Bousman CA, McLeod HL, et al. Recommendations for pharmacogenetic testing in clinical practice guidelines in the US. Am J Health Syst Pharm. 2024;81(16):672-683. doi:10.1093/ajhp/zxae110
- Van Driest SL, Shi Y, Bowton EA, et al. Clinically actionable genotypes among 10,000 patients with preemptive pharmacogenomic testing. Clin Pharmacol Ther. 2014;95(4):423-431. doi:10.1038/clpt.2013.229
- Swen JJ, van der Wouden CH, Manson LE, et al. A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study. Lancet. 2023;401(10374):347-356. doi:10.1016/S0140-6736(22)01841-4
- Caudle KE, Dunnenberger HM, Freimuth RR, et al. Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC). Genet Med. 2017;19(2):215-223. doi:10.1038/gim.2016.87
- No patient information is discussed on this episode.
All planned episodes. To be the guest for this episode, email hello@coloradocarenetwork.com with the episode number.