The Perfect Pill: Medco and CVS Seek to Create Personalized Drugs

The key to personalized medicine is cheaper gene sequencing, but the big application will be medical diagnosis and pharmacogenomics, the practice of using genetic testing to see how patients respond to drugs based on their genetic make-up. For example, patients with a certain kind of genetic make-up do not respond to Plavix, an anti-clotting drug.

This potential future is why CVS Caremark and Medco -- two companies that together manage 100 million American's prescription benefits -- are each investing in ways to make genetic testing more accessible and easier for doctors to interpret.

Medco recently announced the acquisition of the privately held San Francisco-based genetics testing DNAdirect, which offers online tools and educational resources, including a national call center of genetic experts that guide doctors and patients on how to use genetic results to make clinical decisions.

The announcement follows a similar deal between CVS Caremark and Generation Health, a New Jersey-based start-up that also analyzes the effectiveness of genetic tests. More than 200 employers are working with Medco to test the proper dosage of the drugs Warfarin and Tamoxifen, the breast cancer drug. Last week, the Medco Research Institute, which is spearheading the company's pharmacogenomics research, announced plans to release the results of a new study that looks at the effect of Warfarin, another anti-blood clotting drug, on different genetic make-ups.

While these studies and partnerships will help advance personalized medicine, the key is still physician awareness. A recent survey by Medco found that while most physicians polled know that genetic profiles can influence a patient's reaction to a drug, only 10 percent believed they were adequately informed about genetic testing.

Pat Deverka, a physician and researcher at the Institute for Pharmacogenomics and Individualized Therapy at the University of North Carolina, in Chapel Hill, recently told Reason.com

"Physicians understand the concept of pharmacogenomics, but they don't really feel comfortable interpreting the results," she said. "The goal is to identify patients who might have a negative and costly reaction to prescription drugs."

Since today's widely used drugs often produce desired results in only about 50% of patients who receive them, the ability to target specific medications based on a patient's genetic profile could greatly boost treatment results -- while also cutting costs. Each year, 2.2 million Americans suffer side effects from prescription drugs. Of those, more than 100,000 die, making adverse drug reaction a leading cause of death in the U.S. A Journal of the American Medical Association study states that the annual cost of treating these drug reactions totals $4 billion each year.

Partnerships like the Medco/CVS linkup put pharmacies in a better position for the coming revolution in personalized medicine. The next challenge is for more doctors to pay attention and educate themselves about the new tests.

Photo: Lee Nachtigal