Personalized Medicine in Workers’ Comp: How Pharmacogenomic Testing Can Impact Mental Health Treatment for Injured Workers
Summary:
Mental health comorbidities quietly drive up claim costs and recovery times in workers’ comp. Pharmacogenomic (PGx) testing—using DNA to guide medication selection—offers a smarter alternative to trial-and-error prescribing. By matching the right drug to the right patient upfront, PGx testing improves outcomes, reduces side effects, accelerates return-to-work, and delivers measurable cost savings for payers and PBMs alike.
Mental health issues are quietly reshaping the workers’ compensation landscape. Anxiety, depression, PTSD, and adjustment disorders increasingly accompany physical injuries—and when left unaddressed or poorly managed, they extend recovery, inflate claim costs, and stall return-to-work goals.
The problem? Mental health treatment, especially psychiatric medication, is often a long and frustrating game of trial and error. Many antidepressants take up to six weeks to reach full effect, meaning a single “wrong” prescription can set recovery back months—or even years.
That’s where pharmacogenomic (PGx) testing comes in. And it may be one of the most underutilized tools in modern workers’ comp claims management.
Mental Health in Workers’ Comp: High Cost, Low Visibility
Mental health is rarely listed as the primary diagnosis in a claim—but it’s often the invisible factor driving complexity and cost.
A study in the Journal of Occupational Rehabilitation found that up to 40% of workers with chronic health conditions also experience significant mental health issues. Claims involving behavioral health components account for up to 35% of total claim spend, despite representing a small fraction of overall cases6,8. Injured workers with anxiety or depression lose nearly three times more workdays than their peers9.
Traditional approaches fail these workers. Prescribers cycle through multiple psychiatric medications, hoping to find one that “sticks.” In the meantime, injured workers battle side effects, emotional instability, and uncertainty that delay both recovery and closure.
What Is PGx Testing?
Pharmacogenomic (PGx) testing uses a person’s DNA to predict how they metabolize or respond to certain medications [10].
In mental health, PGx testing is especially helpful for:
Antidepressants (SSRIs, SNRIs, tricyclics)
Antipsychotics
Anti-anxiety medications
Mood stabilizers
A simple cheek swab can reveal whether specific medications are likely to be effective, ineffective, or harmful based on genetic variations in liver enzyme pathways (such as CYP2D6 and CYP2C19).
Why It Matters: Key Benefits of PGx Testing
1. Faster Symptom Control
PGx testing allows prescribers to start with medications more likely to work—short-circuiting the months-long cycle of trial and error. Studies show patients guided by PGx results achieve higher response rates and remission faster than those treated traditionally [7].
2. Fewer Side Effects, Better Adherence
Avoiding poorly matched drugs means fewer side effects like sedation, weight gain, and mood swings. In one study, 68% of patients in the PGx-tested group reported no or tolerable side effects—compared to only 51.4% of those prescribed without testing [5].
3. Cost Savings That Compound
The test itself typically costs $200–$500 per person [2], but the downstream savings are substantial.
A 39% drop in inpatient and emergency department visits among patients who received PGx-guided medication management [3].
Earlier return-to-work and reduced disability costs for tested patients [4].
$3,988 average annual savings per member in medication costs alone [1].
Who Benefits the Most
PGx testing isn’t for every claimant—but it’s transformative for:
Workers who’ve failed multiple psychiatric medications
Claims showing early signs of delayed recovery
Cases with depression, PTSD, or anxiety overlays
Injured workers on polypharmacy regimens (5+ medications)
The PBM’s Role in PGx Implementation
Forward-thinking PBMs can lead this evolution by:
Identifying patients who would benefit from PGx testing early in the process
Coordinating tests with treating providers
Supporting medication changes through pharmacist consultations
Tracking outcomes like symptom improvement, time-to-stability, and total cost reduction
Bottom Line
Mental health challenges are no longer the silent passengers of physical injuries—they’re active drivers of claim duration and cost. Precision tools like pharmacogenomic testing bring the clarity and control this space has been missing.
For PBMs, integrating PGx isn’t just good clinical practice. It’s smart business—helping employers lower spend while helping injured workers get back to themselves, and back to work, faster.
By Anna Watson
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
Citations
1. https://pubmed.ncbi.nlm.nih.gov/28238356/
2. https://www.ajmc.com/view/medical-policy-determinations-for-pharmacogenetic-tests-among-us-health-plans?utm_source=chatgpt.com
3. https://pubmed.ncbi.nlm.nih.gov/39358335/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC8370841/
5. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1412-1?utm_source=chatgpt.com
6. https://www.promedview.com/curatedlibrary/understanding-behavioral-health-comorbidities-and-their-impact-on-disability-in-workers-compensation?utm_source=chatgpt.com
7. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-04756-2?utm_source=chatgpt.com
8. https://www.axios.com/2024/05/07/injured-workers-mental-health-attention?utm_source=chatgpt.com
9. https://riskandinsurance.com/early-mental-health-support-can-cut-workers-comp-claim-duration-by-70-sedgwick/?utm_source=chatgpt.com
10. https://medlineplus.gov/lab-tests/pharmacogenetic-tests/?utm_source=chatgpt.com