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Pharmacogenetics in the pharmacy: counseling, medication review and the law

Reviewed by Dr. Daniel Wallerstorfer, molecular biologist and founder of Novogenia · Updated: 13 October 2026 · Reading time: 9 min

Where all prescriptions come together

What happens when the pharmacy itself takes the initiative for a genetic test? Community pharmacies in the Netherlands tried exactly that. Whenever someone came in with a new prescription for one of ten selected drugs – mostly statins such as atorvastatin and simvastatin, plus antidepressants – the pharmacy offered a test covering 40 variants in 8 genes. The result, the predicted phenotype and a recommendation based on the guidelines of the Dutch DPWG went to both the pharmacy and the physician.

Of the 200 people tested, 90% carried at least one result with an actionable recommendation. In 31.0% of the new prescriptions, the drug met such a result head-on – and a concrete therapy recommendation followed. Physicians accepted it for 88.7% of these patients (Bank et al., European Journal of Human Genetics, 2019).

The logical conclusion: the pharmacy is like a train station where all the lines meet. Prescriptions from the family doctor, the specialist and the hospital arrive here, along with over-the-counter drugs from self-medication. Anyone here who knows a pharmacogenetic result sees connections that no single practice notices. Here is what pharmacies contribute, what they may do in Germany, Austria and Switzerland, and how to work well with the medical practice.

What pharmacists contribute

Your strength is the overview. In pharmacogenetics, it turns into a concrete role:

• Medication review: You put the complete medication list next to the result – including over-the-counter products – and flag where a gene and a drug meet.
• Thinking about interactions: Some drugs slow down the same enzyme that the genes control. Genes and co-medication therefore belong in the same check.
• Counseling at the counter: You explain the result in plain words, answer questions and encourage your customer to keep taking their medication as prescribed until the physician has decided.
• Bridge to the practice: You give the prescribing physician a clear, short alert – with gene, phenotype and guideline source.
• Memory for later: With consent, you record the result so that it shows up again with every new prescription.

How well pharmacies work as that memory is shown by the follow-up of the Dutch study: after an average of 2.5 years, the result was on file in 96% of pharmacy systems and in 68% of family practice systems (van der Wouden et al., Genes, 2019). For working together, this means: the pharmacy can be the place where a result reliably resurfaces with the next prescription – and the practice gains when it files the result just as firmly.

In Germany, Section 129(5e) of the Social Code Book V (SGB V) provides the framework for pharmaceutical services that go beyond standard information and counseling – among other things, to improve the safety and effectiveness of drug therapy, for example with multiple medications. If a customer brings a pharmacogenetic result to such a consultation, it is a valuable additional piece of information.

What pharmacies may do in Germany, Austria and Switzerland

Whether a pharmacy may offer a pharmacogenetic test itself depends on national law – and the three countries take three different paths. Here is the short version; the details are in Law: who may offer pharmacogenetics?

Switzerland in detail: It is the only one of the three countries that explicitly names pharmacists as people who may order these tests – with clear ground rules. Pharmacists licensed to practice under their own professional responsibility may order a pharmacogenetic test if:

• a defined selection of genetic variants is tested,
• results of known clinical significance are expected, and
• preventive or therapeutic measures are available according to current science and practice (Art. 5(2) GUMV).

Art. 7 GUMV adds three duties: if the test concerns a prescription drug prescribed by another professional, you consult that professional beforehand. Information and disclosure of the result take place in a separate counseling area. And the result is communicated by a pharmacist who is authorized to order the test – only to the extent that it serves the purpose of the test.

In comparison: Germany leaves ordering to physicians. Austria does not tie pure pharmacogenetics to a physician’s order. Switzerland explicitly opens it up to pharmacies – with a counseling room and consultation with the prescriber.

The process in the pharmacy

Where the pharmacy may offer the test itself – in Austria, and in Switzerland under the conditions above – this process has proven useful:

1. Spot the trigger: a new prescription for a drug with a gene-based recommendation, side effects, lack of effect or many drugs at once.
2. Consult: for a prescription drug, involve the prescribing physician – mandatory in Switzerland, good practice elsewhere.
3. Inform and obtain consent: in the counseling room; what the test shows and what it does not, who receives the result, how the data are protected. More in Data protection and consent.
4. Take the saliva sample: according to the kit instructions, clearly assigned, then off to the lab.
5. Discuss the result: calmly and in plain words, sticking to results that fit the question.
6. Pass it on to the practice: with consent, as a short alert to the prescribing physician.
7. Document: so that the result is visible again with the next prescription.

In Germany, your role starts at step 5: the physician orders the test, and you work with the result your customer brings in.

At the counter: keeping the conversation calm and clear

A pharmacogenetic result raises questions – and sometimes worries. These points help in the conversation:

• Start with the purpose: First explain which drug it is about and which question the result answers.
• Use one image: The gene is the blueprint for a tool that converts a drug. If the tool works slowly, more of some drugs stays in the body – with others, less of the active form is produced.
• Put it in context, don’t alarm: A “poor metabolizer” does not have a disease; it is information for choosing and dosing a drug.
• Give one clear rule: never stop a drug or change its dose on your own – that decision belongs to the treating physician.
• Plan ahead: show the result with every new prescription, including when buying over-the-counter drugs.

How to explain genotype, phenotype and recommendation step by step is covered in Understanding and communicating results.

Working with the medical practice

The European PREPARE study shows that pharmacies and practices can pull this off together: alongside 18 hospitals and nine community health centers, 28 community pharmacies in seven countries took part, including Austria (Swen et al., Lancet, 2023). What the study found is described in Pre-emptive or reactive testing?

In everyday work, a short alert to the practice with the same structure every time helps:

• which drug it concerns and since when it has been prescribed,
• gene, genotype and phenotype from the result,
• what the guideline (CPIC or DPWG) says about this combination,
• your specific question, for example whether an alternative would be an option,
• confirmation that consent to share the result is on file.

That way, the physician has everything at a glance and can decide. How practices build the result into their medication management is described in Pharmacogenetics in medical practice.

Checklist for your pharmacy

• You know the legal situation in your country: Germany – counsel; Austria – offer; Switzerland – order under conditions.
• There is a quiet counseling area – separate and mandatory in Switzerland.
• Information and consent are documented in writing, including consent to share with the practice.
• For prescription drugs, the prescribing physician is involved.
• The medication review covers genes, co-medication and over-the-counter products.
• The alert to the practice is short, structured and names the guideline source.
• Your customer knows: no change to medication without the treating physician.
• The result is recorded so that it shows up with every new prescription.

Frequently asked questions

Related: Law: who may offer pharmacogenetics? · Pharmacogenetics in medical practice · Offer for pharmacies

Note: This guide is general information for businesses and professionals and does not replace medical or legal advice. The genetic traits determined in a genetic analysis are well documented (each gene included is backed by at least three independent studies); recommendations derived from them are logical conclusions, not scientifically proven. Pharmacogenetic results do not replace a medical decision: any change to medication is made only by the treating physician. Regulations can change; errors and changes excepted.