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According to the NIH Precision Medicine Initiative, precision medicine is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.”                                                                     

Pharmacogenomics (PGx) is the branch of pharmacology that deals with the influence of genetic variation on a drug response in patients by correlating gene (Cytochrome P450 - CYP) expression with a drug's efficacy or toxicity. CYP enzymes are essential for the metabolism (biotransformation) of the vast majority of all medications prescribed today.




















When genetic variations are not considered, there is a lower probability of the expected outcome. The result can be a patient left virtually untreated, and an increased probability of an adverse drug reaction. 


Pre-authorization in medicine is an insurer prerequisite, often intended as a cost-containment step in the care and treatment of an insured patient. A  practitioner who expects to be paid for a service must use paperwork and telephone contact with a designated entity, often a TPA, to determine whether the proposed treatment is deemed medically necessary.


Dynamic PGx provides a depth and breadth of information regarding the gene (CYP)/drug and drug/drug relationships (drug description, indication for use, toxic presentation, and more) of a patient’s proposed new medication with regard to the existing medication protocol — PGx. Details in more than 20 distinct categories are available for each of the 400 drugs currently in Dynamic PGx data base. If there are no known drug/drug or gene/drug conflicts, the proposed medication can be pre-authorized.  If there are known conflicts, information regarding alternative treatments is provided.


Thus, companies that subscribe to NeX Step’s PMEP realize:

  • The benefits of genetically-informed decisions rather than the current practice of potentially dangerous guesses;

  • Safer and more predictable patient responses and outcome for prescribed medications;

  • A lower probability of patient ADRs, ER visits, work productivity losses and the accompanying costs;

  • As a result of pre-authorization, the saving of time and money.


PMEP subscriptions are annual and based on a fixed employee count. For each covered employee there is unlimited access to Dynamic PGx and the resulting pre-authorization (by all medications being checked against their genetic profile and existing medication protocol).


In summary:

  • PMEP utilizes pharmacogenomics relationship detail to reduce the 

       employer’s self-insurance health care costs.

  • NeX Step’s software Dynamic PGx creates a patient-specific medication/CYP relationship model. 

  • Using this patient-specific model, a primary care physician or pharmacist or other specialists can: 

    • review a patient's existing medication protocol and be alerted to any drug-drug or gene-drug concerns with regard to the existing protocol; and determine whether -– prior to prescribing a new medication –- the new drug is likely to either not perform as expected or is likely to subject the patient to increased health risks.  In such cases, a list of alternate drugs is provided.

    • By eliminating the scripting of drugs unlikely to function as expected, unnecessary prescription medication expenses are avoided. Wasted drug therapy costs approximately $145 billion per year due to ineffectiveness that in some cases approaches 75% of total initial drug treatment (first 60 days of treatment):


















  • By eliminating the scripting of drugs likely to subject the patient to increased health risks (ADR, death) when aberrant CYP function is present, unnecessary and expensive hospitalization or emergency room expenses have an increased probability of being avoided. 


By utilizing a patient-specific medication/CYP relationship model that takes into consideration the influence of genetic variation on medication response, annual cost savings of from 25 to 40% can be expected. 

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