Employers take a closer look at pharmacogenomics and biomarker testing

Benjamin Franklin once said that “an ounce of prevention is worth a pound of cure,” and employers continue to see that idea reflected in their healthcare costs.

According to a 2025 study, preventive health initiatives were associated with a 3.6x return on investment for participating employers, while engaged employees averaged $359 annually in combined healthcare savings and productivity gains.¹ The success of prevention and early intervention strategies has led to more interest in predictive testing.

Biomarker testing is becoming a more common part of health management as more patients and providers look for an earlier read on chronic disease risk. Pharmacogenomic testing, which evaluates how a patient’s genetic profile may affect their response to specific medications, is emerging as a way to help inform treatment decisions in chronic conditions with high-cost specialty treatment options.

Predictive testing has potential in employer-sponsored healthcare, but its impact on cost management and clinical outcomes will depend on the plan design and oversight behind it.

Earlier detection and more targeted treatment

Biomarker testing and pharmacogenomic testing serve different purposes, but both aim to provide earlier insight into health risks and treatment options. Both approaches are relatively noninvasive and can be administered through at-home testing kits, provider-ordered testing, or third-party laboratory networks.

Biomarker testing has grown as a direct-to-consumer offering, giving patients access to blood test panels that track inflammation, cardiovascular health, metabolic conditions, hormone levels, and other health indicators. Advocates of this approach say it may help identify health risks earlier, before chronic disease develops.

Pharmacogenomic testing, on the other hand, focuses on how a patient’s genetic profile may affect their response to specific medications. It has already gained traction in some specialty drug categories and could become more closely integrated into oncology and autoimmune care as those therapies continue to become more targeted and more expensive. 

Why employer interest is rising

Specialty therapies account for a disproportionate share of healthcare spending growth, even though relatively few members use them. 

Oncology drugs, autoimmune therapies, gene therapies, and cell therapies often carry very high costs, especially when treatment continues long term. In high-cost specialty categories where treatment choices can have substantial financial consequences, pharmacogenomic testing may give employers another way to support more informed treatment decisions and potentially improve cost management.

Employee demand for biomarker testing may continue to grow as more third-party vendors offer direct-to-consumer diagnostic and preventive health screening services at lower prices. Pharmacogenomic testing, meanwhile, may be more likely to gain traction through employer-sponsored healthcare and specialty drug management programs.

Self-funded employers are among the earliest adopters of predictive testing strategies because they bear the direct financial impact of specialty drug spending. Health plans, PBMs, and specialty pharmacy partners have also started to explore how pharmacogenomic testing may fit into specialty drug management and utilization programs, starting with oncology and other high-cost treatment categories.

A 2025 study found that pharmacogenomic implementation efforts are steadily expanding across U.S. healthcare systems, but reimbursement, workflow integration, and provider adoption remain major barriers.²

Governance questions may arrive first

Employers will need clear boundaries between employment decisions and any sensitive medical or genetic information generated through predictive testing programs. Strong data safeguards, ongoing vendor oversight, and proactive member communication strategies will be important parts of any future implementation strategy.

For example, an employee may learn through a plan-covered predictive testing program that they are at elevated risk for a chronic condition and later face an unrelated termination or adverse employment action. Even when an employer believes there is a valid reason for that decision, questions around who had access to predictive health information and whether appropriate safeguards were in place could still create legal and reputational risk.

Tensions could also emerge when pharmacogenomic testing recommendations conflict with member preference; a member may prefer the newest or most intensive therapy available even if testing suggests another treatment may be a better fit. Similar issues could arise if a plan participant with a difficult-to-treat chronic condition still wants to pursue a therapy even after pharmacogenomic testing indicates it is unlikely to be effective.

Broad employer adoption of pharmacogenomic testing, or coverage of biomarker testing, does not seem likely anytime soon. But employers should begin to evaluate how these tools may eventually fit into a broader plan strategy, particularly as they look to keep specialty drug costs in check.

What employers can do now

Predictive testing is not yet a mainstream benefits strategy, but employers are already exploring its role in healthcare and specialty pharmacy management.

Employers do not need a fully developed predictive testing strategy today, but several early planning priorities are already becoming clear:

• Ask PBMs, carriers, and specialty pharmacy partners how predictive testing may eventually integrate into utilization management and specialty drug strategies.
• Bring HR, benefits, and legal leaders into discussions early about whether predictive testing would be positioned as educational, encouraged, or required within any future program structure.
• Establish clear governance principles early around employee privacy, data access, and how predictive testing results are kept separate from employment decisions.
• Review vendor claims carefully, especially around treatment optimization, projected savings, and testing accuracy.
• Monitor how healthcare systems and specialty treatment pathways continue to adopt pharmacogenomic approaches, with an eye toward oncology and autoimmune care.

Source:

1. FitOn Health. “Preventive Care Programs Deliver 3.6x ROI for Employers.” FitOn Health, 2025.
   
2. Clinical Pharmacology & Therapeutics. “Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline Updates and Pharmacogenomic Implementation.” Clinical Pharmacology & Therapeutics, 2025.