Express Scripts Introduces Digital Health Formulary

Since its unveiling in May, Express Scripts’ Digital Health Formulary- a formulary for digital health, medicine, and therapeutics-has been establishing a three-stage formulary review and selection protocol and reviewing hundreds of submissions from digital health developers.

“It is an industry-first endeavor that will allow employers and health plans to manage this emerging segment of healthcare while improving access for patients,” says Mark Bini, vice president of innovation and member experience, Express Scripts. “Digital health is a fast-growing segment of healthcare that aims to help people with serious illnesses like diabetes and high blood pressure to take better control of their health, improve their quality of life, and lower their total costs.”

With more than 300,000 digital products on the market today, it can be overwhelming to figure out which one is best for a specific condition, according to Bini. “Currently, employers and health plans offer digital health programs to their members without a common review process, a way to obtain the best value, or an ability to easily integrate the product into their overall health benefit,” he says.

Participating health plans and employers can increase patients’ access to emerging products and technologies simply and affordably, and can rest easier with the knowledge that these new tools have been reviewed by a team of experts who will ensure the products work, provide a user-friendly experience, and are worth the investment, according to Bini.

“People who use a program on the Digital Health Formulary also will receive support from Express Scripts specialist pharmacists to ensure appropriate use of the technology,” he says.

Following is the three-stage formulary review and selection protocol for digital health solutions:

• Clinical research. Pharmacists, physicians, and health-research PhDs evaluate claims, methodology, and clinical effectiveness.

• Usability. Member experience experts test user-friendliness, tracking, and syncing with other devices and ensure accessibility requirement are met.

• Financial value. Express Scripts will leverage its size, scale, and unique position in the marketplace, digital health companies will want to provide the best value.

“Once a solution is selected and added to the formulary, plans that adopt the formulary can choose to offer it to their members,” Bini says. “When they do, we will handle the end-to-end procurement and implementation, and our pharmacist will provide clinical support to patients who use the digital health program.”

The Digital Health Formulary initially includes 15 solutions, including remote monitoring services and digital therapeutics, that aid in the management of eight common chronic conditions: diabetes, prediabetes, hypertension, asthma, pulmonary disease, depression, anxiety and insomnia.

“The eight conditions we chose to focus on first are among the country’s most urgent conditions, and they are also among the costliest conditions for payers, not just in terms of spending, but also in terms of presenteeism,” Bini says. “It’s also where there is the most innovation in the digital health space. We have plans to add more therapy classes and solutions.”

Related: Cigna-Express Scripts Deal: 5 Takeaways For Health Execs

With the Digital Health Formulary, the groundwork is being set for widespread access and use of digital health among millions of Americans, according to Bini.

“Until now, there has not been a clear roadmap to getting these products out widely to patients or clinicians, or an established plan or path for reimbursement,” he says. “Currently, employers and health plans offer digital health programs one-off to their members without a common review process, a way to obtain the best value, or an ability to easily integrate the product into their overall health benefit. With this formulary, an employer or health plan can more easily and more affordably make a digital health program or therapeutic available to the people who are covered by their plan.” 

The benefits for the digital health company are:

·       The ability to combine their solutions with Express Scripts clinical expertise and insights. 
·       The ability to gain preferred placement on the Digital Health Formulary and, in turn, potential to drive better health for the millions of patients Express Scripts represents.

Plans (and their members) benefit from:

·       A simplified, end-to-end contracting process with the digital health company.

·       Data-driven member engagement campaigns and outcomes reporting administered by Express Scripts.

·       Competitive pricing and value for best-in-class digital health solutions.

·       Integration and support from Express Scripts' condition-specific Therapeutic Resource Centers.

·       Stringent security and privacy compliance by each digital health company.

·       Integration of pharmacy benefit coverage.

“Digital health solutions engage with patients in a variety of ways, allowing them to take better control of their health, keeping them adherent to their medication, and helping them get the care they need, where and when they need it,” Bini says. “Patients who are better engaged in their care are, simply, healthier. They have lower total health care costs and better quality of life, which is a win for the patient and the payer.”