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5 Highlights from BlueCare Network's Rx Precision Medicine Pilot

Analysis  |  By Laura Beerman  
   May 16, 2022

One Michigan plan is bringing predictive power to patient drug treatment.

As the social determinants of health grab healthcare's spotlight, the genetic determinants of health provide precision medicine benefits that one health plan is banking on.

Blue Care Network, a subsidiary of Blue Cross Blue Shield of Michigan (BCBS-MI), has launched Blue Cross Personalized Medicine, the state's first pharmacogenomics (PGx) program. PGx is a subset of genomics that uses genetic testing to help predict an individual patient's response to specific drug therapies.

"Our first priority with the Blue Cross Personalized Medicine program is to ensure that a physician is able to provide the right medication, at the right dose, as early in the process as possible," stated a BCBS-MI press release featuring Dr. Scott Betzelos, Blue Care Network CMO and VP of HMO strategy and affordability.

Blue Care Network serves 670,000 members, a small portion of whom will have access to the program, detailed below:

  1. What: Blue Care Network's PGx pilot will use genetic testing to help predict patient response to prescription drugs. The outcome is a "personalized clinical action plan prepared by a trained pharmacogenomic pharmacist" who then works with the patient's physician design to create a targeted care plan based on PGx results. Patients incur no costs for the program, which Betzelos describes as "an opportunity to bring not only pharmacogenomics to the forefront, but a wrap-around service for our members." Blue Cross Personalized Medicine will include PGx testing for behavioral health, cardiology, cardiovascular, and oncology drugs.
     
  2. Who: MiBiz reports that the pilot includes approximately 500 Blue Care Network Medicare HMO members, with a possible rollout to PPO members. Physicians who believe their patients can benefit order the PGx test, with DNA sample collection managed between the member and Blue Care Network's testing vendor, OneOme.
     
  3. How: Betzelos details the importance of keeping the PGx process secure: "Patients will manage their own DNA sample collection, using OneOme's easy-to-follow at-home kit, which is then mailed directly to the OneOme laboratory where results are processed and then shared only with the patient, their physician and supporting pharmacist provided by OneOme."

    Betzelos adds: "Blue Cross, Blue Care Network and our members' employers are not involved in the test collection or analysis process and are not provided access to the test results at any time."
     
  4. Why: PGx helps predict patient response, versus waiting to see whether a medication works and losing valuable treatment time in the process. In addition to the potential for better outcomes, PGx has the potential to disrupt the prior authorization, step therapy, and quantity limit processes that health plans deploy for utilization management.
     
  5. When: The PGx pilot launched in March 2022, with full HMO expansion planned for January 2023 and PPO a potential for 2024.
     

"It's not that PGx is new," says Betzelos. "[It] has been around for 10 years or so, but the adoption of it is still not where it needs to be, or the awareness for providers." He notes that PGx expanded when the FDA recognized its potential beyond a handful of drugs.

"So, we thought at Blue Cross, let's develop this novel, innovative program, bring precision medicine to the front door of our physicians and our members," says Betzelos, adding: "This is not voodoo medicine. This is real. There is literature that supports it, and we looked at that literature and examined it and wanted to move forward with a program that would provide value to the membership."

Laura Beerman is a contributing writer for HealthLeaders.


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