Express Scripts reveals Digital Health Formulary coverage

Mark Bini

Express Scripts’ new Digital Health Formulary endorses digital solutions for diabetes, cardiovascular issues, asthma, and mental health issues.

First announced in May, the PBM’s formulary includes 15 clinically-validated programs from digital health developers. The solutions, which include remote monitoring services and digital therapeutics, will be included in the Digital Health Formulary’s first release in January 2020.

Related: Express Scripts to launch first digital health formulary

“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. It’s also where there is the most innovation in the digital health space,” Mark Bini, vice president of innovation and member experience for Express Scripts, tells FormularyWatch.

Express Scripts is “laying the groundwork for widespread access and use of digital health among millions of Americans,” Bini says. “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. 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.”

Express Scripts received hundreds of submissions from developers. Then, the PBM put 70 different solutions through its 4-stage review and selection process, before selecting 15 programs in the formulary’s first stage rollout.

For type 1 and type 2 diabetes, Express Scripts’ preferred choice is Living Health for Diabetes. Alternatives include Omada Health for Diabetes and LifeScan’s OneTouch Reveal Plus, powered by Welldoc’s BlueStar platform.

Related: Express Scripts reveals medicare savings plans for 2020

For hypertension, the preferred solution is Living Health for Hypertension, and the alternative choice is Omada Health for Hypertension.

For asthma and COPD, Express Scripts has only one option on its digital health formulary: Propeller Health. For depression, anxiety, and insomnia, Express Scripts selected Learn to Live Cognitive Behavioral Therapy and SliverCloud Health Cognitive Behavioral Therapy.

Pulmonary remote monitoring with the Propeller Health program-in concert with Express Scripts pulmonary specialist pharmacist support-led to improvements in symptoms, an 82% decrease in use of rescue inhalers, and a 10% increase in adherence to controller medications that help to prevent adverse asthma symptoms and exacerbations, Bini says.

“These 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.”

Read more: Formulary changes cause problems for asthmatic kids