CommercialCoverageMedium impact
Do you have time for a Quality Minute about pharmacy measures?
BCBS Michigan·MI · Pharmacy, Internal Medicine, Family Medicine +2 more·Pharmacy
Effective date
Aug 1, 2026
We identified it
Jul 23, 2026
Summary
Blue Cross Blue Shield of Michigan has added two new pharmacy performance measures (COB and Poly-ACH) to their Performance Recognition Program and Value-Based Reimbursements, effective August 2026. Additionally, a new exemption for Statin Use in Persons with Diabetes (SUPD) has been implemented, and a new 1health platform is available to help practices identify and improve medication adherence gaps for diabetes, hypertension, and cholesterol management.
Action Required
By August 2026: Clinical and billing teams must review the new COB (Concurrent Use of Opioids and Benzodiazepine) and Poly-ACH (Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults) performance measures through the BCBSM provider portal. Access detailed guidance via Availity.com > Payer Spaces > BCBSM/BCN logo > Resources tab > Secure Provider Resources > Member Care > Clinical Quality > Pharmacy Clinical Resources. Providers should implement screening protocols to identify at-risk patients and avoid counting members in these measures' numerators, as members cannot be removed once counted. Contact your physician organization or medical care group to enroll in the new 1health platform for medication adherence and SUPD monitoring. Update clinical workflows to screen for SUPD exemption criteria (PCSK9 inhibitors or bempedoic acid use) and document appropriately. Failure to implement these measures may negatively impact performance recognition and value-based reimbursement rates.