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

Document Type

Article

Publication Date

5-11-2026

Abstract

Key Takeaways

  • CPIC/DPWG guidelines enable pharmacists to replace empiric prescribing with actionable gene–drug recommendations, such as CYP2C19-guided P2Y12 selection, DPYD-informed fluoropyrimidine dosing, and CYP2D6/CYP2C19-directed antidepressant choice.
  • Access limitations are driven by reimbursement gaps, insufficient clinician genomics training, suboptimal EHR integration without decision support, and ancestry-biased reference datasets that can reduce predictive validity in marginalized populations.
  • Pharmacist-led end-to-end services can include pretest counseling, ordering, interpretation, EHR documentation, and follow-up, with CPAs enabling independent test ordering and therapy modification while reducing prescriber workload.
  • Economic evidence supports expansion, with most CPIC-guided evaluations cost-effective or cost-saving and real-world programs demonstrating material cost avoidance and medication savings despite ongoing payer-coverage hurdles.
  • Community pharmacies offer a scalable distribution channel, with demonstrated operational feasibility, reliable specimen collection, high provider acceptability, and actionable medication changes in routine practice settings.

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