Opinion: Lower health care costs with personalized medicine

One and a half million Americans suffer from rheumatoid arthritis. The autoimmune disease is far more severe than regular arthritis – it can destroy the cartilage around bones, resulting in physical deformities and permanent immobility. 

Rheumatoid arthritis provokes a great deal of financial pain as well. It costs our economy a staggering $20 billion a year, a third of which is paid by employers. 

It's possible for doctors to keep patients healthy, and costs under control, by adjusting their medication doses to counter "flare ups" – periods when the disease is most active. However, it's tough to predict when a medication isn't working and the next flare up will occur. And it's difficult for patients and doctors to objectively measure disease activity and predict future joint damage. Or at least it was difficult, until recently.

Diagnostic blood tests can quantify exactly how active a patient's rheumatoid arthritis is and how likely it is to cause irreversible joint damage. By covering these tests, employer-sponsored health plans can enable doctors to fine-tune treatment regimens and prevent wasteful medical spending.

That's why our two companies are collaborating to make these diagnostic tests available to thousands of American workers. Diagnostic and genetic testing for rheumatoid arthritis, depression, and scores of other diseases can transform America's health care system.

About half of all Americans get their health insurance from their employers. Many of these employers, particularly large companies, "self-insure" their health plans. That means they pay employees' medical bills directly rather than paying premiums to an insurance company to assume the risk. Roughly six in ten private-sector workers are enrolled in self-insured health plans.

Self-insured employers have enormous influence over workers' well-being because they decide which drugs, tests and treatments to include in their health plans. These decisions create a challenge for employers. If an employer decides to cover every treatment, health care spending could balloon. But if the company refuses to pay for effective drugs and procedures, workers' well-being will suffer.

Personalized medicine powered by genetic testing can help employers strike a perfect balance – one in which they steer workers towards treatments that improve employees' health, while limiting or even reducing long-term medical costs.

Consider how testing enables doctors to select the most cost-effective rheumatoid arthritis treatment. After diagnosing patients with RA, most physicians first prescribe methotrexate. This medicine generally costs, at most, a few hundred dollars per year. 

However, some patients don't respond to methotrexate. So doctors frequently switch patients to "biologic" drugs, which are vastly more expensive – they cost up to $3,000 per month. And patients respond differently to each biologic, so doctors and patients frequently have to try multiple drugs to find the one that works best for each individual.

Myriad's Vectra DA test, which Kroger Prescription Plans now covers, measures proteins in the blood to determine how active a patient's rheumatoid arthritis is on 1-100 scale. The objective score can help physicians determine whether a treatment is working, and has been shown to be more reliable than traditional clinical and diagnostic assessments. 

The relatively inexpensive tests could prevent a doctor from needlessly prescribing an expensive biologic when methotrexate is working well. Conversely, they could show a biologic is needed to prevent permanent joint damage that would otherwise lead to hundreds of thousands of dollars in additional costs. 

Testing could improve the treatment of dozens of other diseases, including depression. Consider a new test – GeneSight – that analyzes patients' genes to predict how they'd respond to 56 possible antidepressants. A recent large clinical trial showed that patients who received the test before their doctors selected a treatment were 50 percent more likely to achieve remission than patients who didn't undergo testing. 

By making such tests available to employees, companies can prevent doctors and patients from having to cycle through multiple antidepressants to find one that works. This averts needless medical spending and restores workers to good health – thereby boosting their productivity.

Employers are constantly striving to keep workers healthy and rein in health care spending. Expanding access to genetic testing and personalized medicine enables them to do both. 

Rich Adams is the senior vice president of Kroger Prescription Plans. Mark C. Capone is president and CEO of Myriad Genetics, Inc.