For some Blue Cross Blue Shield of Michigan members, the days of trial and error with new medications is over.
The Detroit-based insurer launched a precision medicine pilot program with 500 Medicare Advantage patients last month that uses pharmacogenomics, or genetic testing, to determine which medications will be successful based on genetic predisposition.
The program provides a self-administered swab test to the patients and their physician uses the results to determine which medications will work for various common diagnoses including depression, high blood pressure, etc. Results will be delivered to the patient and their physician within three to five days of taking the test, said Julie Hessik, senior director of business development for OneOme, the third-party vendor that will be providing the tests and analysis.
"What this opportunity affords us is to provide the physicians what drug will work the best," said Scott Betzelos, chief medical officer for Blue Care Network and vice president of HMO strategy and affordability for the Blues. "The value is in the reduced complications that can occur. The trial-and-error approach to prescribing medications is alleviated once you have a PGX (pharmacogenomics) test. Your DNA never changes, so the test stays with you for the balance of your life."
BCBSM will not be privy to the genetic testing results, and testing results will not be used for underwriting purposes or to deny or increase the cost of coverage Betzelos said.
The test is free to the current patients in the pilot program and will expand to many more patients in January 2023. It's unknown yet how many will be involved in the full rollout of the program.
For the Blues, the program has the opportunity to eliminate expensive complications from prescribed medicines and therapies as well as eliminate additional prescriptions for drugs that won't work with the patients' DNA.
"There is a value in the program in patient responsiveness, reduced complications and reduced ER visits," Betzelos said. "The patient will also not have to go on multiple medications to find the right one."
Adverse drug reactions are the fourth leading cause of death in the U.S., according to BCBSM, and are estimated to cost $136 billion annually. Adverse reactions also account for roughly 7 percent of all hospital admissions.
This story first appeared in our sister publication, Crain's Detroit Business.