APhA 2025: Advancing Pharmacogenetic Practice in Health Care

Pharmacy Times® interviewed Kelsey Cook, PharmD, BCPS, clinical assistant professor at the University of Florida College of Pharmacy, on her presentation at the American Pharmacists Association (APhA) Annual Meeting & Exposition.

Cook discussed the importance of pharmacogenetics (PGx) resources like Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and PharmGKB, which help guide medication selection and dosing based on genetic information. She highlighted significant barriers to PGx implementation, including limited provider education and insurance reimbursement challenges. Cook explained how genetic testing can reveal how patients metabolize drugs differently, potentially improving treatment outcomes. She also encouraged pharmacists to get involved in the field through specialized training, residency programs, and professional organizations focused on pharmacogenetics.

Pharmacy Times

What resources do you use for PGx guidelines, and how could they be applied?

Kelsey Cook

There are a lot of different resources that are available, but the ones that I use most frequently are generally the Clinical Pharmacogenetics Implementation Consortium or CPIC guidelines. These are really the guidelines that tell us what to do with pharmacogenetic information when we have it. They won't tell you who or when to do pharmacogenetic testing, but if you have the results in hand and you're thinking about using a particular medication that they have a guideline for, this is where you find that information on should I use this drug; do I need to dose adjust it? So, I use those a lot in my practice.

The other really good one that has a wide breadth of information is PharmGKB. I's a website that curates all sorts of pharmacogenetics evidence. It has guideline annotations, so beyond just the CPIC guidelines, looks at different drug labels, a lot of primary literature, and just pulls it all together in one primary space. I's a great spot. You can just go to the website, type in a drug, type in a gene, and see all sorts of information that is available for it.

Pharmacy Times

What's the biggest barrier to PGx implementation, and how would you address it?

Cook

There are quite a few barriers. I think some of the bigger ones that I've been experiencing the past year or 2 with my practice. Education is a big one.Our providers don't really know about pharmacogenetics, and if they've heard of it, they're not very comfortable applying pharmacogenetics to patient care. That's where we can really step in as pharmacists to then say we’re the medication experts we've been trained in this. Here's how you can use this information. Me and my team will do a lot of education for providers, whether it's CE during rounds, one on one meetings, just really anything we can do to make them more comfortable using the information. The other one is definitely insurance reimbursement, which is probably no surprise to anybody. That one is definitely going to take us a little bit more work to really work with the insurance companies to say what data do you need to see in order to convince you to pay for this testing?

Pharmacy Times

How would you explain PGx coverage to a patient? ow would you explain PGx coverage to a patient?

Cook

What it is, is we're really doing genetic testing where we're just looking at little pieces of DNA that have been associated with drug response. There are a couple different things that we can look at, but a lot of what we look at is really related to pieces of DNA that encode for proteins or drug metabolizing enzymes that sort of turn off and turn on medications in the body. What we can look at is say does this DNA result mean that the patient's going to have a protein that works slower or faster than the average person, which can impact then how they ultimately respond. If we do the testing, we find out they have a particular protein that's going to work slower than the average person, and maybe we want it to prescribe or recommend a medication that needs that protein in order for the medication to be turned on to really work. If their protein doesn't work, then the medication is not going to work for them. It's just not going to be effective. If we know this ahead of time, we can just give them something else that maybe isn't impacted by that genetic difference leading to that protein change.

Pharmacy Times

How do you stay updated on PGx advancements, and what recent development is impactful?

Cook

There's definitely a lot of advancements and things to stay on top of. What I find the most helpful is just being involved in different organizations or being really connected with others in the field. There are all sorts of organizations you can join. CPIC is a great one, it's free. They do monthly meetings where they talk about guideline updates and other big things to the field. Pharmacogenomics Global Research Network, there's just kind of something for everyone. Then a lot of our other pharmacy organizations will have special interest groups, usually for pharmacogenomics. That's a great way to meet other people that are doing the same thing as you, but with a different spin on it, so we all can collaborate and learn from each other. One of the biggest advancements, or exciting things, at least in my personal opinion, is related to the insurance side of things. A lot of states are now proposing and passing these biomarker legislations that are mandating that either Medicare, Medicaid, depends on the state, and what their legislation is that they would have to cover biomarker testing. Which, when we read it looks like it should cover pharmacogenetic testing because it specifically talks about genetic testing and genetic testing related to treatment plans.

We're really excited. Especially I'm in Florida, so our biomarker bill in Florida looks like Medicaid is going to have to be paying for pharmacogenetic testing. We're really excited about that and hoping that this is really a step in the right direction to get better insurance coverage, to provide really better access for patients.

Pharmacy Times

Is there anything you would like to add?

Cook

Something I always like to share is, like I said, pharmacists have a great opportunity to get involved in pharmacogenetics as the medication experts. A lot of programs across the country are being led by pharmacists. There are different ways the pharmacists can get involved or get specialized training to any of the students out there. There are residency programs, fellowship programs. Those are great options if that's something that you are interested in. There's also different like CE certificates online. There are different programs available, so just depending on your level of interest, they have really great introductory training modules about different disease states and applying pharmacogenetics. It's something you can do at home, on your own time. It's just a great way to learn more and get your feet wet in the space.