Dear Governor Newsom,

Last year, you and the California State Legislature took a huge step toward advancing patient safety and curtailing spiraling healthcare costs by enacting AB 425 Medi-Cal Pharmacogenomics (PGx) into law (Chapter 329). This law mandating Medi-Cal coverage for PGx testing has an implementation date of July 1, 2024 and represents a budget solution in this time of financial crisis.. 

The Department of Health Care Services has requested to delay implementation of the coverage. Due to the law's importance in increasing patient safety and saving our healthcare system millions of dollars, the undersigned respectfully urge you to move forth with the original implementation date when determining budget items for the May Revise.

Pharmacogenomics is the science of how a patient’s genes impact the way they process medications. Findings from PGx tests have implications about the medication type and dosage that a patient should be receiving, which can optimize patient safety and care. This information produces more in savings with reduced need for healthcare utilization — such as emergency department visits and hospitalizations — than it incurs with the cost of testing. 

The prevention of adverse drug events (ADEs) through genetics-informed prescribing can be the difference between life and death for patients. A high school student courageously shared her story about how a PGx test saved her life after months of struggling with ineffective anti-depressants, moving Asm. Alvarez and the California Legislature to unanimously advance AB 425. While crucial for mental health, the importance of this test and coverage extends to all patients, given that genes affect the metabolism of medications across many different conditions., It is shown to reduce suicide attempts in people with Major Depressive Disorder, increase deaths in patients with a DPYD variant undergoing chemotherapy if not utilized to optimize dosing, and increase the chance of a patient developing opioid use disorder if not incorporated into selection and dosing of pain medication,, and provide patient insights that would not be possible using any other test/method. 

A recent study of ~7000 patients in 18 hospitals, nine community health centers, and 28 community pharmacies in seven European countries​ showed a 30% reduction in clinically significant adverse drug events in just 12 weeks with the use of pharmacogenomic testing. A meta-analysis of multiple studies using PGx confirmed a 32% increase in medication changes, and 43% reduction in hospitalizations.

Due to ADEs, the United States loses the equivalent of four full 737 airplanes in lives every day and spends over 528 billion dollars each year. Given California’s large population, that results in almost 40,000 preventable deaths and at least $84 billion in spend each year. Access to, and implementation of, PGx testing within our Medi-Cal population can greatly reduce that number. 

With the understanding that savings will be realized within a few months of testing, we implore you to ensure that DHCS moves forward with the original implementation date of July 1, 2024 for Chapter 329. Thank you for your consideration of this important matter.

Sincerely the undersigned,