Pharmacogenomics Offers New Roles, Opportunities for Pharmacists

Aislinn Antrim: Hi, I'm Aislinn Antrim with Pharmacy Times, and with me is Jamie Wilkie, founder of PGx Consulting Confidence Academy and co-founder of Own Your PharmD, to discuss pharmacogenomics and how they are playing a role in the future of pharmacy. So, to kind of start with the basics, what are pharmacogenomics and how do you use them to provide personalized precision medicine?

Jamie Wilkie, PharmD: That's a great question, Aislinn. So, pharmacogenomics is a really long word, but it really comes down to understanding how genetics affect our medication because one medication does not work the same for everybody. And genetic factors have to be considered when we're looking at prescribing medicine for people because, especially with different ethnicities, people can metabolize medications wildly differently. And living in 2022, it's very important that we're addressing this genetic component and making sure we get patients the right medication, at the right dose, at the right time for their body, that works for them, to decrease the guessing that's in prescribing right now and the trial and error, in order to just go right to what works for them.

Aislinn Antrim: Very interesting. And can you talk about the experience of starting your own pharmacogenomics-based consulting practice? And what it is that you do?

Jamie Wilkie, PharmD: Yes. So, once I learned about pharmacogenomics—because I actually went a long time in my career without ever even hearing that word or knowing what it was—once I understood the science of pharmacogenomics, it felt like this is a big deal. How can I be a pharmacist and not use this for my patients? And so, while it took a lot of legwork to roll it out in my community, just knocking down doors, talking to everyone, I could talk to them telling them what I can do. It was really rewarding to ultimately set up my own practice and start seeing patients and help them in a way that no one had ever helped them in their lives before. So, it was actually meaningful patient interactions that I had been craving my whole professional life. I was able to create a practice that met their needs and helped me be the pharmacist I always want it to be.

Aislinn Antrim: Absolutely. That's so wonderful. Can you talk a little bit about the development of pharmacogenomics as a field?

Jamie Wilkie, PharmD: Yes. So, pharmacogenomics has been around for more than 20 years, it is not a new science. And yet, it's still not standard of care. Very few people have had a genetic test done and have their health care team on board with making sure that all prescribing aligns with their genetic results. And I think the hardest part is the integration into the health care system. There are several barriers, the biggest of which is just that it's a really technical science. And no other profession is as well-equipped as ours, as pharmacists, to really understand those pharmacokinetic [and] pharmacodynamic pathways, and how our genetics influence it. And so, where I see the bright future of pharmacy and genetic medicine coming together is when pharmacists and PharmDs really champion this and bring it to their patients. Because I mean, we're already medication experts. And it's a perfect alignment.

Aislinn Antrim: Absolutely. How are pharmacists currently using pharmacogenomics in their work? And how could they be using it kind of what is the potential of this?

Jamie Wilkey, PharmD: So, few, unfortunately, too few are using it right now. There's some really great clinics and academic centers and universities who have amazing PGx programs that are really taking good care of their patients. But for the most part, your so- called “regular pharmacists,” I think, are still unfamiliar with it and are not using this, especially in very traditional settings. Like in retail settings, it almost doesn't exist. And so, there's a lot of room for adoption and creating this role for ourselves as we change the scope of where pharmacy is going into the future.

Aislinn Antrim: Absolutely. What is the importance of having personalized precision medicine? And how is this becoming increasingly widespread?

Jamie Wilkey, PharmD: That is a really great question. And right now, it's such an important time to be treating our patients uniquely because patients are resisting being treated like everyone else, and they know that they're unique, and they needed to be treated as such. If everyone in line for the pharmacy counter has the same prescription at the same dose for the same drug, it's not going to work the same for everyone. And especially living through a pandemic and a mental health crisis, people are saying, my health comes first. I need to be treated like me, not like everyone else, and so our patients are craving it.

And there's clear proof that we need to change how we're addressing medications because right now, adverse medication events are the fifth leading cause of death in the United States. COVID just passed it. It used to be the fourth leading cause of death in the entire country. which shows that there is such a big problem with getting the right medications to people. And while PGx doesn't solve that problem completely, getting the right dose of the right drug the first time would dramatically improve our patient outcomes and provide cost savings.

Aislinn Antrim: Definitely. How do you predict the use of pharmacogenomics will continue to develop and be used in the pharmacy field?

Jamie Wilkey, PharmD: So, I see the adoption of pharmacogenomics as standard of care being inevitable into the future—ideally, much sooner rather than later. And that everyone will understand that genetics are important, have an important role in not only their medication, but their overall health. And so, it'll just be a part of their electronic health record and a part of who they are as they're treated by the entire medical team. And not just pharmacists.

But specifically, I see pharmacy being the ones to really champion this integration into the different software platforms as well as across the different health care entities so that as a doctor prescribes a medication in the clinic, the pharmacist in a retail setting, they're both speaking the same language and making sure it's optimized for the patient. And it is a very complex process, and it has roadblocks ahead, but there's just no other way, knowing what we know about how we can help patients. And the level of knowledge we have as PharmDs. This is the future of our profession, is really helping people with complex knowledge, understanding their medication, and optimizing their health. And so, while there are barriers ahead, it also is a really great opportunity for our profession to shine. So, I'm very excited about it.

Aislinn Antrim: How are pharmacists adapting to the new patient expectations that are associated with personalized care?

Jamie Wilkey, PharmD: Pharmacists are doing neat things right now and they're really being especially entrepreneurial in this space. Because in traditional settings, you have only a limited scope of work of what you can and can't do at work. And pharmacists are seeing patients in their community suffering and not having optimal health. And so, I am seeing them creating their own businesses and creating solutions to problems they see out there. So rather than just complaining about the problems, they're actually creating solutions. They're creating their own companies that are consulting either patients directly or partnering with prescribers and being a consultant pharmacist with the prescribers or even with independent pharmacies in the community and other wellness clinics. So, it's really exciting to see the need for change in pharmacists not just waiting for that change to come to them, but controlling their career and saying, “I want to have control of my future.” I want to do something I love that I know truly helps my patients instead of just medicating my patients. So, I'm going to solve the problem by starting a side hustle and then growing that into something truly amazing and shaping our profession.

Aislinn Antrim: Absolutely! Well, seeing all of this down the road will be so exciting and interesting. Thank you so much for speaking with me about it.