Preventable Toxicity: The Pharmacogenomics Case for DPYD Testing in Oncology | Precision Medicine Pharmacist Podcast

Welcome back to PPN – The Precision Medicine Pharmacist. In part one of our series, Precision Psychiatry in Practice – A Pharmacist–Physician Collaboration, we explored how a collaborative approach can begin to reshape psychiatric care — building trust, aligning perspectives, and creating space for more personalized treatment. Today, we move deeper into what that looks like in real-world, integrative medicine psychiatry. I’m excited to welcome back Dr. Saba Arshad, joined by Dr. Afshan Khan, as we explore how their partnership brings together different clinical perspectives to care for the whole patient — not just symptoms, but the broader context of mental health, lifestyle, and individualized needs. In this episode, Precision in Practice: Real Stories, Real Results in Integrative Psychiatry, we focus on the human side of collaboration. How do two clinicians with different training and strengths come together to approach complex cases? What does shared decision-making really look like in practice? And how does this integrative model shape better patient outcomes? We’ll walk through real patient cases, explore the dynamics of their collaboration, and uncover how this partnership continues to evolve to meet patients where they are. If part one introduced the foundation, today’s episode brings that collaboration to life. Let’s dive in.

Welcome to PPN – The Precision Medicine Pharmacist, the podcast where science, innovation, and collaboration are redefining patient care. We are kicking off a special two-part series titled Precision Psychiatry in Practice – A Pharmacist–Physician Collaboration. In this series, we explore how precision medicine is reshaping mental health treatment — and what becomes possible when pharmacists and psychiatrists work together with shared clinical goals. Today’s episode, The New Frontier: How Pharmacists and Psychiatrists Are Teaming Up for Precision Mental Health, focuses on how this collaboration began — the challenges that inspired it, the early conversations that shaped it, and the practical steps taken to bring pharmacogenomics into psychiatric care. Joining us is Dr. Saba Arshad, clinical pharmacist, founder of Med DNA Health, and a strong advocate for integrating pharmacogenomic insight into mental health treatment. We will also hear from Dr. Afshan Khan, psychiatrist and clinical partner in this model of care, as we explore how their professional paths aligned to create something new. In this first episode, we will lay the foundation — examining the “why” behind precision psychiatry and the systems that had to evolve to support it. Then, in part two, Dr. Khan will join us more extensively as we move from framework to real-world impact, sharing patient cases, clinical outcomes, and lessons learned from implementing precision medicine in practice.

Fluoropyrimidines such as 5-fluorouracil (5-FU) and capecitabine remain cornerstone chemotherapies in oncology. However, for patients with certain DPYD gene variants, these commonly used drugs can cause life-threatening toxicities due to impaired metabolism of the active compounds. In this episode of the Precision Medicine Pharmacist Podcast, host Melissa Smith, PharmD, explores how DPYD genotyping is transforming oncology care by helping clinicians identify patients at risk before toxicity occurs. Joined by Karen Merritt, an advocate for universal DPD testing and leader with the Test4DPD initiative, the discussion sheds light on how pharmacogenomics is shaping safer, more personalized cancer treatment. Together, they explore current evidence, new FDA updates, and implementation frameworks that empower pharmacists and oncology teams to prevent preventable harm through precision medicine. 🧠 Key Discussion Topics The science behind DPYD gene variants and their clinical implications How undiagnosed DPD deficiency contributes to preventable toxicity New recommendations from the CPIC® Guideline for Fluoropyrimidines and DPYD Insights from the Guide for Implementing DPYD Genotyping for Systemic Fluoropyrimidines Advocacy for universal DPYD testing across oncology centers How pharmacists can champion pharmacogenomic testing integration in oncology workflows Updates from the FDA-approved labeling for Xeloda (capecitabine) 🎧 Featured Guest Karen Merritt LinkedIn Profile Karen Merritt is a passionate advocate for pharmacogenomic testing and patient safety in oncology care. Through her leadership in the Test4DPD movement, she works to expand awareness and adoption of DPYD testing worldwide, ensuring patients are protected from severe chemotherapy-related toxicities. 📚 Resources & References Guide for Implementing DPYD Genotyping for Systemic Fluoropyrimidines into Clinical Practice (PMC) CPIC® Guideline for Fluoropyrimidines and DPYD Advocates for Universal DPD/DPYD Testing – Test4DPD Updated FDA-Approved Label for Xeloda (Capecitabine)   💊 About the Show The Precision Medicine Pharmacist Podcast explores the evolving role of pharmacists in precision health, pharmacogenomics, and individualized patient care. Each episode highlights clinical insights, implementation strategies, and inspiring stories from professionals leading the way in personalized medicine.

This episode dives into the future of pharmacy through the lens of pharmacogenomics (PGx). Dr. Melissa Smith speaks with Dr. Vanessa Lesneski about the steep decline in pharmacy school enrollment and how PGx could reignite interest in the profession. They explore how PGx has rapidly evolved from an elective to a core component of pharmacy education, the rise of certification and training pathways, and the expanding career opportunities in diverse care settings. The discussion also tackles critical questions around pharmacists’ role in test interpretation, skepticism about PGx adoption, and what it will take for the field to move from niche to mainstream.

Introducing Melissa Smith, PharmD, CPH, CPGx, Founder of Florida PGX Consulting, and the new host of the Precision Health and PGX Podcast! Dr. Melissa is joined by her guests Dr. Jamie Wilkey & Dr. Jackie Boyle to discuss their introduction to precision medicine in PGX, as well as their friendship that encouraged it!

Be sure to tune in to this episode of the Precision Health and PGX Podcast as Dr. Becky Winslow, and Dr. Angela Cassano, PharmFusion Founder and owner, discuss Dr. Cassano’s personal pharmacogenomics testing and how the results impacted her breast cancer treatment, the tamoxifen and CYP2D6 pharmacogenomics clinical utility research currently available, whether CYP2D6 testing for patients prior to tamoxifen is National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO) recommended, and whether insurers in the United States reimburse the testing. This is a must listen for those interested in the clinical pharmacogenomics’ current landscape and a pharmacist-patient’s perspective about PGx testing.    lTPwO46QarrPEaNcmreC  

Be sure to tune in to this episode of the Precision Health and PGX Podcast as Dr. Becky Winslow, CEO of inGENEious RX Incorporated Pharmacogenomics Consulting, and Dr. Megan Landsverk, Scientific Director of MolDX® and Chief Science Officer of Palmetto GBA®, discuss how laboratories may overcome the challenges they face earning MolDX® coverage and reimbursement for their clinical pharmacogenomics tests. Specific to coverage determinations, the PGx veterans discuss test design, post-genotype translations, and technical assessments. Specific to reimbursement, the duo discusses evidence-based reporting and complete claim submissions. Also discussed is the importance of labs clearly defining intended use populations for tests and academic partnerships importance when labs develop and validate panels including drug-gene pairs the Clinical Pharmacogenetics Implementation Consortium and the United States Food and Drug Administration does not recognize as clinically utile for managing medications.  Dr. Megan Landsverk is a Science Officer for Palmetto GBA, a Medicare Administrative Contractor (MAC) and a Science Director for the Molecular Diagnostic Services (MolDX) program developed to identify and establish coverage and reimbursement for molecular diagnostic services on behalf of Medicare. Dr. Landsverk received her PhD in Biochemistry and Molecular Biology from Baylor College of Medicine and postdoctoral training in Medical Genetics at the University of Washington. She is a board-certified Molecular Geneticist, completing her molecular genetics fellowship at Baylor College of Medicine. She has held multiple academic faculty positions and has numerous publications in the field of genetics. Prior to joining Palmetto, she served as a clinical laboratory director in academic, hospital, and commercial clinical laboratories and has experience in several genetic specialties including rare disease (pediatric and adult), cancer (somatic and inherited), and pharmacogenetics.   lTPwO46QarrPEaNcmreC

Equitable biomarker testing access, including pharmacogenomics testing, is critical for patients to experience optimal medication therapy outcomes. Be sure to tune in to this episode of the Precision Health and PGX Podcast as Dr. Becky Winslow, Dr. Behnaz Sarrami, and Hilary Goeckner, Director of State & Local Campaigns - Access to Care of the American Cancer Society Cancer Action Network (ACS CAN), educate listeners about ACS CAN’s mission, how it executes on its mission, accomplishments, and future goals.  This episode is a must listen for anyone who wants the latest update on the American Cancer Society Cancer Action Network’s work influencing state legislatures to pass legislation to expand coverage of biomarker testing, states who have already passed legislation and those with pending legislation, and to learn how they too can advocate.   After listening to this episode, listeners will be able to describe biomarker testing’s importance in healthcare; describe how the American Cancer Society Cancer Action Network is championing biomarker testing coverage legislation; name states that have passed biomarker testing legislation and those with pending legislation; know how one can contribute to the efforts to increase biomarker testing coverage. Hilary Gee Goeckner is director of state and local campaigns for the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. In this role she leads work with ACS CAN staff and coalition partners across the country to improve access to comprehensive biomarker testing, clinical trials, fertility preservation and other health care access issues. Prior to this role, Hilary served as the Kansas government relations director for ACS CAN. Before joining ACS CAN, Hilary served as director of health policy at Kansas Action for Children. She holds a bachelor’s degree in anthropology and global health from Williams College and a master’s degree in social work from Boston College. She lives in San Diego with her husband and two children. As the CEO of inGENEious RX Incorporated and pharmacogenomics subject matter expert, Dr. Becky Winslow has dedicated over a decade to providing innovative solutions for pharmacogenomics stakeholders. Her extensive experience also includes directing pharmacy operations and medication safety programs across diverse clinical settings, spanning retail, hospital, long-term care, and public health. Dr. Winslow is a passionate educator, training Doctors of Clinical Pharmacy to work with molecular testing stakeholders and serving as an advanced pharmacy practice preceptor for Manchester University’s Master of Science in Pharmacogenomics Program. She hosts an evidence-based educational podcast, The Precision Health and PGx Podcast, which Welp Magazine recognized as the ninth most listened to genetics podcast globally. Her involvement with prominent organizations like the Clinical Pharmacogenetics Implementation Consortium and the National Council for Prescription Drug Programs (NCPDP) PGx Task Force speaks to her expertise and commitment. Dr. Winslow frequently presents at national conferences such as The Association for Molecular Pathology and holds degrees from Campbell University.  Behnaz Sarrami, PharmD, MS, is a leading expert in pharmacogenomics and a dedicated Medical Science Liaison (MSL). She is named American Pharmacists Association’s (APhA) "50 Most Influential Leaders in Pharmacy" and Medika's "Top 30 Women Transforming Healthcare". Behnaz is passionate about advancing personalized medicine to optimize treatments and improve patient outcomes, especially in underserved populations. She supports healthcare professionals through scientific training and presentations. As the host of the "Precision Health and PGx" podcast, she mentors pharmacists transitioning into MSL roles and those launching pharmacogenomics consulting careers. She earned her Master’s in Biochemistry from Georgetown University and her Doctorate in Pharmacy from Creighton University. With significant contributions to research and education, she continues to drive innovation in pharmacogenomics through her work with healthcare professionals and community outreach programs.   lTPwO46QarrPEaNcmreC  

Be sure to tune in to this episode of the Precision Health and PGX Podcast as Dr. Becky Winslow, Dr. Behnaz Sarrami, and Dr. Jeremy Stuart, Chief Scientific Officer and laboratory director for Precision Genetics, discuss pharmacists value as employees in clinical pharmacogenomics testing laboratories. Having employed pharmacists in his laboratories, Dr. Stuart will provide his first-hand examples to illustrate how pharmacists have benefited his laboratories. Dr. Winslow and Dr. Sarrami will also share their real-world experiences working for clinical pharmacogenomics laboratories to help the laboratory achieve its goals. This episode is a must listen for laboratories who are vested in their pharmacogenomics testing's financial success.  After listening to this episode, the learner will be able to describe responsibilities and roles in pharmacogenomics pharmacists fulfill in clinical labs, name specific real-world examples that illustrate pharmacists’ contributions to pharmacogenomics in the clinical laboratory, and name education, training, and work experiences that prepare pharmacists to assume advanced practice roles in clinical laboratories.   Dr. Jeremy Stuart has extensive experience in the life science industry. He specializes in commercial operations, technology development and transfer, manufacturing design, and validation of laboratory developed tests (LDTs). He currently serves as the Chief Scientific Officer for Precision Genetics and serves as their Laboratory Director.  Dr. Stuart was part of the senior management team that completed a management buyout of Lab21 Inc. to form Selah Genomics and the subsequent sale of Selah to EKF. Dr. Stuart led the development and validation of all of Selah’s molecular assays and oversaw their clinical studies. Dr. Stuart was also a member of the Agencourt Personal Genomics team, where he co-developed the SOLiD next-generation sequencing technology that was subsequently acquired by Applied Biosystems.   Before entering industry, Dr. Stuart completed his postdoctoral work at the the Harvard School of Public Health, earned his master’s degree in Toxicology from the University of Minnesota, and his doctorate in Genetics & Complex Diseases from Harvard University.  As the CEO of inGENEious RX Incorporated and pharmacogenomics subject matter expert, Dr. Becky Winslow has dedicated over a decade to providing innovative solutions for pharmacogenomics stakeholders. Her extensive experience also includes directing pharmacy operations and medication safety programs across diverse clinical settings, spanning retail, hospital, long-term care, and public health. Dr. Winslow is a passionate educator, training Doctors of Clinical Pharmacy to work with molecular testing stakeholders and serving as an advanced pharmacy practice preceptor for Manchester University’s Master of Science in Pharmacogenomics Program. She hosts an evidence-based educational podcast, The Precision Health and PGx Podcast, which Welp Magazine recognized as the ninth most listened to genetics podcast globally. Her involvement with prominent organizations like the Clinical Pharmacogenetics Implementation Consortium and the National Council for Prescription Drug Programs (NCPDP) PGx Task Force speaks to her expertise and commitment. Dr. Winslow frequently presents at national conferences such as The Association for Molecular Pathology and holds degrees from Campbell University.  Behnaz Sarrami, PharmD, MS, is a leading expert in pharmacogenomics and a dedicated Medical Science Liaison (MSL). She is named American Pharmacists Association’s (APhA) "50 Most Influential Leaders in Pharmacy" and Medika's "Top 30 Women Transforming Healthcare". Behnaz is passionate about advancing personalized medicine to optimize treatments and improve patient outcomes, especially in underserved populations. She supports healthcare professionals through scientific training and presentations. As the host of the "Precision Health and PGx" podcast, she mentors pharmacists transitioning into MSL roles and those launching pharmacogenomics consulting careers. She earned her Master’s in Biochemistry from Georgetown University and her Doctorate in Pharmacy from Creighton University. With significant contributions to research and education, she continues to drive innovation in pharmacogenomics through her work with healthcare professionals and community outreach programs.

In this episode, Dr. Mary Weissman, Dr. Lexi Wensel, and Dr. Becky Winslow discuss Medicaid’s coverage of pharmacogenomics testing and Medicaid’s reimbursement of a pharmacist’s time spent provisioning PGx testing and providing PGx inclusive medication therapy management for Medicaid beneficiaries. We teach the listener how to locate, navigate, and understand Medicaid-managed care organizations’ coverage and reimbursement policies for pharmacogenomics testing and the billing codes pharmacists can use to bill for their time in providing PGx testing. Lastly, we analyze pharmacists' time investment versus Medicaid reimbursement of the pharmacists' time to project the financial return on investment of this business model for pharmacists.     After listening to this episode, the listener will understand what Medicaid and Managed Care Organizations (MCOs) are and their role in pharmacogenomics utilization; understand how to navigate managed care organizations' policies to determine coverage for pharmacogenomic testing and eligibility criteria; recognize the current Medicaid coverage landscape for pharmacogenomic testing, including eligibility criteria, coverage limitations, and variations across different states; and understand pharmacists' roles in the provision of pharmacogenomics testing and Medicaid’s reimbursement of a pharmacists’ time.