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A message from Dr. Scott Betzelos, vice president of HMO Strategy and Affordability at BCN
We’re moving forward with Blue Cross Personalized Medicine
 As I wrote in a previous column in this newsletter, Blue Care Network launched Blue Cross Personalized Medicine℠, a program that uses genetic testing to personalize medication treatments, in January 2023. I wanted to provide an update on the program — and an overview of our efforts over the past year — to provide a better understanding of why this program is so important.
BCN has contracted with OneOme, an independent precision medicine company, to offer eligible BCN members pharmacogenomic (PGx) testing to aid health care providers with personalized medication guidance based on individual genetics and clinical guidelines. Participation in the program is at no additional cost to members. We anticipate the program will increase medication adherence and decrease the risk of adverse drug reactions. Eligible members are invited to participate based on advanced analytics, which determines who is most likely to benefit from PGx testing.
PGx-certified pharmacists assess the testing results and offer recommendations to primary care physicians and prescribers. Test results remain private between the member and their providers and are never shared with BCN.
We conducted a pilot program for eligible BCN Advantage℠ members last year. Following the pilot, eligible members, including BCN commercial members, started receiving invitations to participate in PGx testing beginning in January 2023.
Pilot program results
As part of the 2022 pilot, we invited 12,700 members to participate in PGx testing, of which 587 requested a test kit. A total of 436 members (74%) returned their test kits and received lab results, with clinical action plans shared with their providers.
PGx testing resulted in 432 medication recommendations, which affected 396 members (90.8%). Early data from the pilot suggests a reduction in outpatient visits, emergency room visits and inpatient hospitalizations, as well as reduced total health care spending, among those who received PGx testing.
What you can do
Providers can further drive clinical benefits for members by ordering, reviewing and implementing PGx test recommendations and dosing changes. Here’s how you can order the test:
- Visit MyRightMed.com/BCBSM-providers.*
- Create an account by entering your NPI number followed by the first two characters of your first name and the first two characters of your last name, including any special characters.
- Approve each request in order for patients to receive the kit at their home.
Ultimately, program success will depend on the active engagement of primary care providers who authorize testing, review test results and act upon clinical recommendations.
Educational opportunities
During the pilot, we focused our educational efforts on primary care providers and behavioral health specialists. We offered live training sessions, which were recorded and remain available for virtual on-demand access. (See details on accessing training later in this column.)
For the 2023 program, additional live virtual educational opportunities are planned for providers and their support staff, each focusing on a different therapeutic area:
- Cardiology (March 27, 8 a.m.)
- Oncology (April 26, noon)
- Behavioral health (May 24, 8 a.m.).
Accessing training and other information
You can register for the upcoming live sessions or participate in on-demand sessions by visiting our provider training site. Use the search feature to search for “personalized.” The on-demand sessions appear after the search completes. Click on the Events tab to find out about the upcoming training opportunities.
If you haven’t yet registered for the provider training site, follow these steps:
- Open the registration page.
- Complete the registration. (We recommend using the same email you use to communicate with Blue Cross for provider-related needs. This will become your login ID.)
- Follow the link to log in.
You can find additional pharmacogenomics information on our provider portal by following these steps:
- Log in to our provider portal (availity.com).*
- Click on Payer Spaces on the Availity menu bar.
- Click on the BCBSM and BCN logo.
- Click on Secure Provider Resources (Blue Cross and BCN) on the Resources tab.
- Choose Blue Cross Personalized Medicine from the Member Care drop-down menu.
For more information
To learn more about Blue Cross Personalized Medicine, testing or pharmacogenomics, I invite you to visit myrightmed.com/bcbsm-providers* or call OneOme at 1-844-663-6635 (TTY: 711), from 8 a.m. to 6 p.m. Eastern time, Monday through Friday.
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