BCBS 'Evidence Street' Group Enabling Engagement With MDx Players

Evidence Street, the Blue Cross Blue Shield Association's web-based evidence review platform for medical products that's been operational for around 15 months, is continuing to grow its influence within the diagnostics sector and among payors. Several molecular diagnostics companies, which as a sector generally cite reimbursement coverage as one of its biggest headaches, recently touted Evidence Street opinions on their tests as milestones. Moreover, MolDx, a program run by Medicare contractor Palmetto GBA that evaluates the clinical utility of molecular tests and determines coverage, may soon be using Evidence Street's assessments. "At Evidence Street, our expertise is evidence review. We don't make coverage decisions," said Suzanne Belinson, the BCBS executive director who manages the platform, in an interview. "And in fact, in 2017, MolDx is going to stop doing evidence reviews and leverage ours." BCBS clarified after publication of this story that the contract with Palmetto is not yet finalized for 2017. Evidence Street evaluates peer-reviewed publications, summarizes the data, and makes a judgement as to whether the published literature provides "strong evidence" for a particular technology, and notes for example, if there are biases in the clinical studies conducted. Using this information, the plans "have total latitude to make their own coverage decision," Belinson said. "Coverage is more complex than just a review of the evidence. It's one piece.” Evidence Street will not be writing Medicare policy," Jacques added, but he agreed with Belinson that the arrangement with Evidence Street could free up MolDx to focus more of its resources on developing and maintaining local coverage determinations. "They still have to go through advisory committees, give public notice, and publish draft and final policies." he said. "LCD development is a heck of a lot of work." Moreover, having Evidence Street do a technical assessment wouldn't preclude MolDX from doing its own technical reviews if necessary to address questions that specifically arise from the Medicare program rules or the special needs of the beneficiary population. Nonetheless, Evidence Street's assessments carry weight, not just among BCBS member plans, but in the broader payor community. The biggest insurers in this country, such as Aetna and Cigna, cite its opinions in their coverage decisions. Stakeholders can access Evidence Street opinions through its website, which requires a password for access under a subscription agreement. Depending on the type of organization, some subscribers will pay more than others, and some may get free access. Regardless of Evidence Street's subscription model, if Palmetto is planning to use that information in its Medicare coverage decisions, then the content of those technology assessments may have to be more widely accessible, Jacques predicted, because of Medicare requirements for public transparency and stakeholder input in coverage policymaking. The advantage to a drug or test manufacturer that pays for a subscription to Evidence Street is that they can receive information about the timing of a review, use a structured format for submitting evidence, access Evidence Street's assessments, and importantly, receive feedback from experts about the evidence they included and excluded, as well as the gaps in the current evidence.  

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INDUSTRY NEWS TAGS: Molecular Diagnostics

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