Payers, Diagnostics

CareFirst BCBS, ExoDx band together on studies for diagnostic tests

Through CareFirst’s new HealthWorx program, the organizations are working together on evidence development studies for ExoDx diagnostic tests.

An insurer is teaming up with a diagnostics company.

Through its new HealthWorx program, Baltimore, Maryland-based CareFirst BlueCross BlueShield is collaborating with Waltham, Massachusetts-based Exosome Diagnostics (ExoDx).

The HealthWorx program allows CareFirst to join forces with early stage companies such as ExoDx.

More specifically, the organizations are working together on evidence development studies for ExoDx diagnostic tests. Together, they will select which diagnostic tests should be studied, as well as the qualifications of participants.

To begin, the groups will focus on the diagnostics company’s ExoDx Prostate IntelliScore test (EPI), which was launched last September. It helps physicians improve the prostate biopsy decision-making process. Providers can use the noninvasive test to more accurately predict whether a patient doesn’t have high-grade prostate cancer and could avoid an initial biopsy.

In a statement, CareFirst CMO Rahul Rajkumar explained:

One of the challenges presented by prostate-specific antigen (PSA) cancer screenings is the relatively high number of false positives detected from PSA results which often fall into a ‘gray’ zone and require further testing through biopsies. These prostate biopsies often find the false positives to be benign or low-grade cancers for which treatment or intervention is not clinically indicated. Unfortunately, this course of care can lead to medically unnecessary prostate biopsies and avoidable complications for our members. We are excited about the evidence to date and potential for ExoDx’s EPI test to better inform physicians and members’ decisions on which course of action to pursue when facing a PSA result in the gray zone.

Overall, the study will supply additional evidence to assist CareFirst clinicians and members. It will be provided through certain urology group practices in Maryland.

In an emailed response to questions, ExoDx CEO John Boyce said CareFirst’s goal is to pinpoint tests that will improve patients’ lives and cut costs.

“CareFirst identified the EPI test, and Exosome Diagnostics as a company, that could achieve these goals,” he said. “CareFirst’s HealthWorx program could significantly speed coverage for the EPI test.”

After demonstrating the clinical efficiency of the EPI test, CareFirst and ExoDx plan to work together on and potentially speed coverage for additional tests.

“ExoDx currently has a pipeline of well-developed Dx tests that it will work with CareFirst on, through the Coverage with Evidence Based Development program,” Boyce said.

Looking ahead, Boyce noted success in this endeavor will be achieving reimbursement of the EPI test, as well as additional indications in the pipeline.

Photo: Natali_Mis, Getty Images