Response to comment on “Restrospective cohort study of ambulatory care pharmacist interventions' impact on incidence of therapeutic response in anxiety and depression”

We thank Zecopoulos and colleagues1 for their comments on our recent paper and their perspective on the potential benefits of pharmacogenomic (PGx) testing outside of this study. We acknowledge that our study was not powered to test the hypothesis that PGx testing improves patient outcomes for anxiety and depression.2 Referrals from primary care providers to conduct PGx testing create opportunities for pharmacists who are not psychiatric specialists to co-manage mental health conditions. The visits conducted by pharmacists in our study were not only for PGx testing but also to optimize the patient's therapy plan by adjusting doses, ensuring medication access, changing to alternative drug therapy, or educating patients about their medications. While we agree that PGx can be helpful in guiding pharmacotherapy, there are financial barriers and clinical considerations regarding appropriate use that limit its utility. Patients referred for pharmacist co-management do not consistently have the desire to conduct PGx testing or may not have an appropriate treatment history to support its use. In cases where pursuing PGx is of interest, insurance companies have shown variable reimbursement, which significantly impacts patient out-of-pocket costs.3 Lastly, many health systems do not have the functionality to order and integrate PGx results within their electronic health record for use during future encounters with the patient by providers; therefore, limiting utility. The promising results of the PRIME trial do indicate that PGx could be a catalyst for achieving remission sooner.4 Until PGx testing is widely available, our study supports pharmacist co-management as a potential solution to the ongoing provider shortage. Increased access to PGx testing may become a pillar of interprofessional mental health management in primary care as pharmacists are the qualified leaders to guide test interpretations. We look forward to additional studies evaluating the use of PGx within this setting. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.