We have received multiple questions regarding the impact the Blue Cross Personalized MedicineSM program has on your annual Product Exhibits. As a reminder, this is the program that uses genetic testing to personalize medication treatments.
In general, this program will be treated like all other plan-led or vendor-led programs, and the impacts to each MCG Product Exhibit are as follows:
BCN Commercial – Targets include claims savings expectations for plan-led and vendor-led programs. When savings are achieved, the MCG shares in those savings, as stipulated in the Product Exhibit. For example, if an MCG is at 50/50 risk, the MCG and the Health Plan equally share in any savings achieved. Non-Claims Benefit Expense (NCBE) is not part of the BCN Commercial payment exhibits.
The genetic test itself is not billed through claims, so the cost of the test will not impact your BCN Commercial claims expenses. The cost of the test is a payment arrangement between BCN and the vendor.
BCN AdvantageSM Gain Share – Targets and settlements include claims savings and costs for plan-led and vendor-led programs that are classified as NCBE. For 2023, the NCBE cost expectations are expected to be minimal and were not incorporated into your 2023 target. As such, the costs of the program will not be hitting your expenses at settlement either. We anticipate the program to provide more savings potential in the future and, therefore, it will be incorporated into your BCN Advantage targets and expenses (NCBE) in future years.
Early data from the pilot program we ran in 2022 suggests a reduction in outpatient visits, emergency room visits and inpatient hospitalizations, as well as reduced total health care spending, among those who received a pharmacogenomics (PGx) test.
For more information about the program, see We’re moving forward with Blue Cross Personalized Medicine in the March-April 2023 issue of Hospital and Physician Update.