Pharmacogenomics and how the VA is improving the efficacy of medicine through DNA

PGx testing is a form of genetic (or DNA) testing that helps predict how Veterans process and may respond to different medications. There are specific genes linked to specific medications. VA doctors and pharmacists can now order genetic tests to prevent side effects and to improve medication responses when prescribing medications.

In 2019, the Imagenetics program at Sanford Health and VA teamed up to offer pharmacogenomic (PGx) testing to current VA patients at no cost. PGx testing analyzes genes to learn how you may respond to commonly prescribed medications used to treat pain, mental health, selected cancers and infections, cardiovascular, neurologic, and inflammatory disorders. 

“We are the first hospital in the region to offer PGx testing,” said Dr. Danish Khattak, VASNHS Pharmacogenomics Pharmacist. “This is a unique opportunity that will provide information to help doctors and pharmacists decide the best treatment options for our Veterans.” 

Any Veteran patient is eligible to receive PGx testing through this program. PGx testing helps reduce the trial-and-error process of trying different drugs in varying doses. Side-effects can be reduced when PGx testing is used because VA providers are alerted of a potential “drug-gene” interaction when ordering medications.

What is genetic testing?

Genetic tests look for differences in your genetic makeup (DNA) that are linked to certain health conditions, physical traits, disease risk, or how you respond to medicines.

VASNHS offers pharmacogenomic (PGx) tests. PGx tests determine how you process or respond to medicines based on your genetics, allowing providers to better pick the dose or type of your medicines. The goal of using PGx testing is to decrease side effects and improve the beneficial effects of your medicines. 

How is PGx testing different from other genetic tests?

The PGx test mainly focuses on how your body processes or responds to medicines. It is not a test that tells you if you are likely to develop common diseases like heart disease or cancer. It is not a test that will tell you where your ancestors came from.

Will this PGx test show my risk for any diseases?

The PGx test may identify an increased risk for certain, uncommon, health conditions that were passed down to you from your parents. In this case, you and your provider will be informed, and your provider will talk to you about what (if any) next steps are recommended.

How do PGx tests help my provider make better decisions when prescribing medicine?

PGx results help your provider better understand how your body processes or responds to many common medicines. They use this information to treat you, as an individual. Along with other medical information, providers use PGx test results to determine if there is a better dose or type of medicine for you. 

Can VA PGx testing affect my Service Connection?

No. Genetic test results cannot be used to deny or reduce a Veteran’s service-connected benefits.

Who can get tested?

Currently, Veterans who receive their health care at a participating VA facility offering PGx tests can get the VA PGx test.

Is this test available at VASNHS?

Yes, VASNHS is one of the first sites that has made this testing available for all Veterans. All VAs are invited to participate in this program and testing will be rolled out in stages to participating VA sites nationwide. 

What does this test cost?

There is no cost to Veterans for the PGx tests offered through the VA PGx program. 

Who do I contact to get PGx testing ordered?

Please talk with your VA provider(s) about this test. They can explain the test, answer your questions, and if you agree, order the test for you.

How do I get the test done?

The VA lab draws a small blood sample and sends it to the lab for testing.

Is the test performed at the VA?

The blood draw is done at the VA. The VA PGx program may work with a non-VA lab to process results.

Are there risks with PGx testing?

The physical risks of testing are like other tests that require a blood sample. These risks include fainting and pain or bruising at the site of the puncture. It is possible that the treatment recommendations based on the test results may include medicines that are more expensive or not preferred by the VA. Be sure to discuss these issues with your provider.

How long does the test take?

It may take up to 2 weeks for results to be available for you and your provider.

Who will have access to the test results?

Your VA provider that ordered your PGx test will receive your test results. The results will also be stored in your VA medical record for all your VA health care providers to review. As with all laboratory vendors, the testing lab also keeps copies of the genetic test results (your DNA and blood sample are destroyed, however). We will also send a copy of your test results to you in the mail. If you have providers outside the VA, you may want to share results with them.

Who will talk to me about my results?

Your provider who ordered the test may talk to you about results and answer questions you may have. If they can’t answer your questions, they may direct you to another provider who can.

How will my PGx test results be used?

Your test results tell providers only part of the story. Other things like your age, overall health, other medicines you take, and body size also affect how your body responds to medicines. Your provider will use all these factors to prescribe the most appropriate medicines and doses for you.

What should I do with my test results?

PGx test results can be complex. Talk with your provider about questions or concerns. If you see more than one provider, please share your test results with your other providers. This is especially helpful if a provider starts a new medicine for you or if you get care outside the VA.

Is this a research study?

No, this is not a research study. This test is like other labs, such as cholesterol and blood counts, ordered by your provider. The test results are intended to be used as part of your healthcare.

How is my PGx information protected?

Your PGx test results are protected in the VA medical record and cannot be shared outside VA without your permission unless there is a court order. If testing is done by a non-VA lab, they need to follow the same privacy rules to protect your information as the VA.

How long can my PGx results be used in my medical care?

PGx test results do not change over time, so for most patients, repeat testing is not needed. We’ll update your VA medical record with any new information. If your provider thinks you need to be tested again, they will talk with you.

What are limits of PGx testing?

Genetics tells us only part of the story. Other factors like age, overall health, other medicines you take, and body size also affect how you respond to medicine. The VA PGx test only checks certain genes that we know affect selected medicines. There may be other medicines that you are taking that are affected by genes we do not test for.

Can my family members get tested?

Testing through the VA PGx program is only available to VA patients. However, other types of PGx testing are available outside the VA. If your family member is interested in testing, they should talk to their provider. 

How does this program differ from the Million Veteran Program (MVP)?

The Million Veteran Program (MVP) is a research study that aims to better understand how genes affect health. The VA PGx test program is a clinical test used to improve medicine prescribing for you. You can participate in MVP research and get PGx testing if you choose.