Expanding Pharmacogenomics Access and Economic Sustainability Through Pharmacy-Led Precision Medicine

Pharmacogenomics (PGx) has transitioned from a research-focused innovation to a practical clinical tool that can improve medication safety and therapeutic outcomes. Today’s barriers to PGx access are rarely technological. Instead, they stem from the complexities of clinical interpretation, workflow integration, and reimbursement. As medication experts, pharmacists are uniquely positioned to address these barriers by leveraging their expertise in therapy optimization and demonstrating measurable economic value.

Moving Beyond the Lab: Translating Genetic Results into Action

The standard approach to pharmacotherapy has relied heavily on empiric, trial-and-error prescribing. However, decades of clinical research now support a targeted approach. The Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group have established robust, peer-reviewed guidelines detailing actionable gene-drug interactions, providing pharmacists with the evidence base needed to proactively optimize therapy.^1,2

In cardiovascular care, CYP2C19 genotyping guides antiplatelet therapy after percutaneous coronary intervention. Identifying intermediate and poor clopidogrel metabolizers enables pharmacists to recommend alternatives such as prasugrel or ticagrelor, thereby reducing adverse events. In oncology, DPYD testing before fluoropyrimidine chemotherapy helps pharmacists recommend dose reductions or alternatives to prevent toxicity. In behavioral health, PGx panels help determine which selective serotonin reuptake inhibitors or selective serotonin-norepinephrine reuptake inhibitors are appropriate based on CYP2C19 and CYP2D6, shortening time to remission and reducing the need for prolonged medication trials. Implementation guidance from institutional PGx programs highlights that pharmacists frequently interpret genotype results, provide structured therapeutic recommendations, document gene-drug interactions within electronic health records (EHRs), and coordinate follow-up and medication monitoring.

Challenges to PGx Access

Despite the proven ability of PGx to improve medication safety and efficacy, equitable access remains severely limited by several primary barriers³:

• Financial constraints: Inconsistent insurance coverage and a lack of standardized reimbursement models often leave patients with high out-of-pocket costs, making PGx a privilege rather than a standard of care.
• Provider education and competency: Many prescribers lack formal training in genomic medicine. There is a recognized need to expand genetics and pharmacogenomics competency education across the health care workforce to ensure health care providers have the confidence to translate genetic phenotypes into actionable prescribing decisions.²
• Technological integration: EHRs frequently fail to integrate complex genomic data. If results are buried in static files rather than triggering automated clinical decision support alerts, the test loses its value at the point of prescribing.
• Health equity and genomic disparities: Genomic databases historically overrepresent populations of European descent. This lack of diversity has reduced the predictive accuracy of PGx tests for marginalized groups, creating a systemic barrier that can inadvertently exacerbate existing health disparities if not intentionally addressed.

How Pharmacists Can Improve Access

Pharmacists are well positioned to overcome barriers and serve as PGx champions. As accessible medication experts, they can improve access in several ways⁴:

• End-to-end clinical implementation: Pharmacists are key at every PGx stage, managing workflows from pretest counseling and test ordering to interpreting results and posttest management.
• Advocating for equitable implementation: Pharmacists can promote inclusive testing and use PGx to reduce health disparities, acknowledging current genomic data limitations.
• Advancing competency education: Expanding PGx education for students and pharmacists through curricula prepares a workforce to lead precision medicine and educate prescribers.
• Community integration via collaborative practice agreements (CPAs): By using CPAs, pharmacists can order PGx tests and adjust therapies independently, thereby improving access and reducing prescriber workload.

Economic Metrics That Support Expansion

Historically, genotyping costs have hindered PGx adoption, but recent research demonstrates how pharmacists have addressed these concerns through measurable cost avoidance and medication optimization. A systematic review by Morris et al determined that approximately 71% of CPIC-guided PGx evaluations are cost-effective or cost-saving.⁵ This results in an adjusted cost avoidance of $1983 per participant in a program of all-inclusive care for the elderly—with 70.5% prescriber acceptance—and $621 annual prescription savings per long-term care patient after replacing high-risk medications.⁶ Despite these benefits, securing consistent reimbursement remains a hurdle.⁷ As Cavallari and Pratt note, expanding payer coverage requires ongoing real-world evidence of clinical utility and cost-effectiveness to elevate PGx testing from out-of-pocket to fully reimbursed care.⁸

Community Pharmacy: A Scalable Access Platform

Community pharmacies are among the most scalable health care touchpoints in the United States. With broad geographic distribution and frequent patient interactions, pharmacists in this setting are well positioned to expand PGx access beyond academic centers. In a study of 150 patients across 17 community pharmacies, Haga et al demonstrated the operational feasibility of integrating pharmacist-delivered PGx testing into routine practice. The initiative achieved a 100% specimen collection rate, with high provider acceptability, and resulted in actionable medication changes for 8.7% of participants. These findings highlight substantial scalability, proving that PGx testing can be seamlessly embedded into community workflows without disruption.⁹

Conclusion

Access to pharmacogenomics is now a medication management issue, not just a technological challenge. As health care shifts toward precision medicine and value-based care, demand for gene-guided therapy grows. Pharmacists with expertise in pharmacotherapy, workflow, and economic accountability are best suited to lead. By removing access barriers and integrating PGx into routine care, pharmacist-led services offer a scalable, measurable, and economically viable path to personalized medicine.

REFERENCES

1. CPIC Guidelines. Clinical Pharmacogenetics Implementation Consortium. Accessed March 6, 2026. https://cpicpgx.org/guidelines/

2. Kisor DF, Farrell CL. Expanding pharmacist and student pharmacist access to genetics/genomics/pharmacogenomics competency education. J Med Educ Curric Dev. 2019;6:2382120519834325. doi:10.1177/2382120519834325

3. Paetznick C, Okoro O. The intersection between pharmacogenomics and health equity: a case example. Pharmacy (Basel). 2023;11(6):186. doi:10.3390/pharmacy11060186

4. Maruf AA, Aziz MA. The potential roles of pharmacists in the clinical implementation of pharmacogenomics. Pharmacy (Basel). 2023;11(6):180. doi:10.3390/pharmacy11060180

5. Morris SA, Alsaidi AT, Verbyla A, et al. Cost effectiveness of pharmacogenetic testing for drugs with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines: a systematic review. Clin Pharmacol Ther. 2022;112(6):1318-1328. doi:10.1002/cpt. 2754

6. Bain KT, Knowlton CH, Matos A. Cost avoidance related to a pharmacist-led pharmacogenomics service for the Program of All-inclusive Care for the Elderly. Pharmacogenomics. 2020;21(10):651-661. doi:10.2217/pgs-2019-0197

7. Saldivar JS, Taylor D, Sugarman EA, et al. Initial assessment of the benefits of implementing pharmacogenetics into the medical management of patients in a long-term care facility. Pharmgenomics Pers Med. 2016;9:1-6. doi:10.2147/PGPM.S93480

8. Cavallari LH, Pratt VM. Building evidence for clinical use of pharmacogenomics and reimbursement for testing. Clin Lab Med. 2022;42(4):533-546. doi:10.1016/j.cll.2022.09.009

9. Haga SB, Mills R, Moaddeb J, Liu Y, Voora D. Independent community pharmacists' experience in offering pharmacogenetic testing. Pharmgenomics Pers Med. 2021;14:877-886. doi:10.2147/PGPM.S314972