A Q&A with Dr. Scott Betzelos, Chief Medical Officer and Vice President of HMO Strategy and Affordability at Blue Care Network
ABlue Care Network’s pilot program brings the era of precision medicine or genetics deeper into the mainstream of modern healthcare. As part of the pilot project launched in early March with approximately 500 Medicare patients, Blue Care Network is proactively contacting physicians to have genetic testing performed for patients diagnosed with a condition or disease to identify the drug that suits them best. Blue Care Network intends to fully roll out the program in January 2023 at no cost to members and may expand to PPO members in 2024. MiBiz discussed the pilot that uses pharmacogenomics, or PGx, with Dr. Scott Betzelos, chief medical officer of Blue Care Network, the 670,000-member HMO affiliate of Michigan’s Blue Cross Blue Shield.
What does this pilot really represent for Blue Care Network?
The pilot project represents BCN’s ability to bring a new and innovative program to market for its members and suppliers. It’s not that PGx is new. PGx, which stands for pharmacogenomics, has been around for about 10 years, but its adoption is still not where it needs to be, or the awareness of vendors using PGx and which drugs would be susceptible to a gene-drug interaction. The increase in knowledge about precision medicine or personalized medicine is largely about tailor-made treatment for oncology patients to examine cancer genomics and biomarkers. It’s about the genomics and DNA of the individual and whether or not they can metabolize a drug. This is therefore an opportunity to bring not only pharmacogenomics to the fore, but also a global service for our members.
How does the pilot project differ from the way Blue Care Network currently handles requests for genetic testing?
A doctor may order a PGx test and think about doing it because a member is not responding to behavioral health medication, for example. They then get the PGx test. What we do is proactively identify and predict members who have a potential gene-drug interaction through our provider, then we send letters to the provider and the member and an at-home test is done, then we have a pharmacist who will support the provider when the result comes back, especially for more complex patients. It’s about predicting whether or not a drug is going to work when you’re put on it when someone has a diagnosis.
What is your goal?
What we want is to get people on the right medication, at the right time, as early in the process as possible, and this program gives us that opportunity. The potential lies in the value delivered to members in terms of reduced complications, reduced drug interactions, reduced emergency room visits, reduced hospitalizations, reduced trial and error associated with multiple medications and multiple associated costs. The value is important for our members, and there is also value for the supplier and our pharmacist who makes the recommendations.
What do you hope to learn from the pilot?
We want to test our approach to how we do it. We want to see if suppliers feel supported. We want to know if members feel supported. We also want to test members’ confidence in the program. Blue Cross Blue Shield does not receive any genetic data. We have a robust firewall built so that we don’t. And we also want to know a bit more about those who have been tested and compare their adherence to medication.
Very often a patient starts taking a drug and it comes and goes. Some of the literature supports the fact that if you have a PGx test you are more likely to continue taking any medication you are taking.
Bottom line: Is it better medicine?
It’s better medicine, absolutely. And I believe that will quickly become the standard of care over the next few years.
This is a real opportunity to approach health care on an individual basis and adapted to the individual needs of each member. By working closely with our members and their physicians, we are now able to take the guesswork out and make informed decisions that lead to sustainable treatment options and better patient outcomes.
Why do this at this precise moment?
Medicine continues to evolve, and when PGx first came out in the late 2000s…it was really just one or two drugs, and then it started to grow. Then it continued to evolve until the FDA started recognizing these gene-drug interactions and it quickly became routine for us to do this type of testing. So, we thought of Blue Cross, developing this innovative new program, bringing precision medicine to the front door of our physicians and our members, specifically around pharmacogenomics. This has evolved to the point where several labs perform this type of testing and are certified.
It’s not voodoo medicine. It’s real. There is documentation that supports it, and we reviewed that documentation and reviewed it and we wanted to move forward with a program that would provide value to members.