Health Insurers Offer DNA Tests for Drug Response

Two major Australian health insurers, Bupa and Medibank, have started offering genetic testing meant to tell you your likely reaction to certain medications.

These include antidepressants, pain medications and ones to manage your cholesterol or heart health.

This pharmacogenomic testing can tell whether a drug is likely to work in a certain person, the best dosage, or if that person is at increased risk of side-effects.

But is Australia ready for much wider pharmacogenomic testing than it already provides?

What are health insurers offering?

Bupa last week announced it will offer 10,000 free pharmacogenomic tests to its customers before the end of the year.

The kits will be sent by post and involve taking a mouth (cheek) swab at home. They cover your likely responses to more than 100 medications .

Test results go to your GP. Unless your GP bulk bills, you will have to pay an out-of-pocket fee to see them to receive the results.

Medibank started offering pharmacogenomic testing in July this year. However, it offers partial coverage - up to A$500 depending on the level of extras cover, for tests a clinician orders for a "clinical purpose".

So Bupa is taking a universal approach by offering many people testing for many possible responses. Medibank's approach only covers tests ordered by clinicians for a specific clinical need.

Should I get tested?

If you are a Medibank customer, you can ask your doctor whether pharmacogenomic testing is appropriate for you. However, there are a few considerations for people thinking about the Bupa testing.

The test is likely to have some use for some of the 10,000 people tested. So for many, the potential benefit may outweigh any concerns.

Concerns may include where your genetic data is stored and who might have access to it.

Bupa says genetic test information won't be shared with any other part of Bupa.

However, the 23andme data breach is still fresh. In 2023, the genetic testing company had a massive data breach, and the issue of DNA data security is not going away.

Bupa says genetic test information won't impact someone's health insurance premium.

The Commonwealth government has also just released draft legislation to ban genetic discrimination in life insurance. When that legislation is passed, it will be illegal for life insurers to charge higher premiums, or deny you coverage, based on health risks revealed by genetic testing, including pharmacogenomic tests.

Do we already have pharmacogenomic testing?

Medicare already reimburses some types of pharmacogenomic testing for specific purposes.

For example, the drug abacavir is given to some people with HIV. But people with a specific gene variant (the HLA-B*57:01 allele) are at increased risk of a life-threatening allergic reaction. So Medicare reimburses this testing to see if the person is at risk of this side-effect.

Late last year, the Royal College of Pathologists of Australasia called for Medicare rebates for more pharmacogenomic tests .

The college has also gathered evidence and advice for doctors about pharmacogenomic testing related to several drugs .

However, it is not proposing these tests for entire populations, but only for people with a clinical purpose. This is similar to Medibank's approach.

Are we ready for wider pharmacogenomic testing?

Governments are discussing the prospect for much wider genomic testing. This could test whole populations for genetic variants that predict disease risk or influence how certain medicines work.

Genomics Australia , part of the Department of Health, Disability and Ageing, was launched on July 1 this year. It has sought feedback on its National Health Genomics Policy Framework , which includes the future of population genomic testing.

The question is whether Australia is ready to roll out such population-wide testing.

If you test for many pharmacogenomic variants, many people will have results that could be relevant if they ever require certain medications.

But how would the test results be disclosed and explained to people who had been tested? Who would do this? We know many GPs lack confidence with interpreting and using genetic test results.

What about results where there is no immediate benefit? How would they be integrated into the health system and made available at the time they became relevant? For example, will a paramedic treating an injured patient in the back of an ambulance know their pharmacogenomic testing results before providing pain medication ?

Do the results apply to diverse populations? The Royal College of Pathologists of Australasia notes we lack data on the applicability of tests to diverse groups, including First Nations people.

Finally, are the potential benefits sufficiently cost-effective to warrant the funding of such testing at the population level?

For governments to introduce population screening programs, they need to consider issues including equity of access, relevance of the test to the whole target population, the need for an established policy for management of high-risk people, and cost-effectiveness.

These principles apply to other DNA screening programs too.

For example, DNA Screen , the study I co-lead at Monash University, has piloted DNA screening for people at high genetic risk of conditions such as certain types of cancer and heart disease. We carefully designed our program considering such population screening principles.

Is this the future of health screening?

Genomic technology will continue to advance, and commercial interests will continue to seek opportunities to provide DNA testing, including pharmacogenomic testing.

However, for equitable, evidence-based population DNA screening programs, we need government investment.

Only with sufficient research can we begin to consider whether population-scale pharmacogenomic testing is ready for prime time.

Jane Tiller receives funding through an Investigator Grant from the National Health and Medical Research Council. She is co-lead of the DNA Screen study, which was funded through the Australian government's Medical Research Future Fund. In the past, she was a legal consultant for a short period for myDNA, the company now doing pharmacogenomic testing for Bupa.