Payer Precision Medicine Program Covers At-Home Genetic Tests

Blue Cross Blue Shield of Michigan is making at-home genetic testing available to members as part of a precision medicine approach to care.

The payer will cover genetic testing through Blue Care Network, the company’s nonprofit health maintenance organization (HMO), which covers 840,000 members.

“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,” said Scott Betzelos, MD, chief medical officer and vice president of HMO strategy and affordability at Blue Care Network.

“This is a real opportunity to address health care on a person-by-person basis that is tailored to each member’s individual needs. Working closely with our members and their physicians, we are now able to cut out the guess work and make informed decisions that lead to sustainable treatment options and better patient outcomes.”

The payer partnered with a precision medicine vendor, OneOme, to give members access to at-home genetics testing. Once eligible members receive a DNA sample collection it, they can follow the instructions in the packet and mail it to the vendor.

The vendor can analyze the DNA sample for 27 genes. Using this data, the vendor can assess how a member may react to different therapies, which can help prevent adverse drug events. The press release indicated that this approach could have an impact on securing better results in behavioral healthcare, oncology, cardiology, and other expensive chronic diseases.

Only three people have access to the data once it is available: the member, their provider, and their pharmacist from the precision medicine vendor. 

The vendor’s pharmacogenomic pharmacist collaborates with the member’s provider in order to build a treatment plan around the precision medicine at-home testing kit’s data. Members and their providers can determine how and whether to act on the pharmacist’s suggestions.

As the use of precision medicine continues to grow, enforcing genetic data privacy is a high priority. This is evidenced in the number of states jumping to enact genetic data privacy laws. In light of this, Blue Cross Network emphasized its efforts around health IT security.

“We understand and respect the sensitivity that people have when it comes to protecting their genetic information, and we have built robust protections into our program,” Betzelos added.  

“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.”

Additionally, the payer underscored that the results of the genetic testing kit would not be used for underwriting or coverage denials or cost increases, nor do members have to pay extra for this service.

Blue Cross Blue Shield of Michigan is running a pilot in 2022 and will roll out the product more broadly in January 2023.

Payers are leveraging precision medicine in various ways to combat chronic diseases.

For example, Aetna established a provider network specifically designed around gene therapies. This benefit became available as a standard medical benefit in 2022.

One evolving resource is multicancer screenings. These screenings can use precision medicine to detect more than one type of cancer, reducing the number of tests that a member may have to undergo to assess the risk or presence of cancer.

While the benefits of such a concept are numerous, payers would have to overcome multiple hurdles before offering coverage. The tool needs more evidence of its clinical benefits, a national coverage determination for Medicare coverage, clinical integration, and other barriers.