Insurance Access to Digital Therapeutics Continues to Grow

Telehealth was not the only technology that saw an increase in use during COVID-19. The pandemic has spurred increases in interest and the use of health apps and digital therapeutics. But reimbursement and coverage for these digital solutions are still evolving.

Express Scripts, an Evernorth company, and CVS Health were the first PBMs to offer a Digital Therapeutics Formulary in 2019. Last month, Evernorth expanded its Digital Health Formulary to include five new app-based programs to help people better sleep, anxiety, alcohol and opioid use disorders, and inflammatory conditions. Evernorth’s plan now has 20 digital health options across nine categories available to patients and is available to about 20 million members.

Ashley Jenne

In many cases, solutions are offered at no cost to members. “Our goal is to give patients access to new and affordable options to improve and maintain their health, while making it easier and cost-effective for our clients to include these solutions in their plans,” Ashley Jenne, managing director, strategy and business development at Evernorth, told Formulary Watch in an interview. “The digital health formulary is one of the ways that we can connect employers, insurers and patients with those innovative, affordable and evidence-based care that meets their broader healthcare needs.”

Plan sponsors can choose to offer individual digital solutions for their population or incorporate them into one of Evernorth’s connected care programs, which safely integrates biometric data from the digital health solutions with pharmacy, medical, and lab data. Within a specific condition, some digital health solutions may be listed as preferred based on enhanced value that the solution offers, Evernorth officials said. Company officials say the Evernorth Digital Health Formulary delivers average administrative savings of more than $120,000 per solution.

Jenne said that each solution on the digital health formulary is reviewed for its clinical application, for privacy and security, ease of use, and affordability. The solutions do not have to be FDA approved but do require some evidence of effectiveness. Each solution is reviewed by a panel of pharmacists, physicians, and health services researchers, and they assess claims methodology and clinical efficacy of each solution. This assessment typically includes reviewing published peer-reviewed studies, clinical protocols, case studies and other evidence that supports the solution. Each solution must meet standards for data security, privacy, usability, and value to be deemed worthy of a client’s consideration.

“We also conduct routine market checks to ensure that our stringent requirements are maintained, and that those solutions continue to drive value for our clients, and most importantly, their members,” Jenne said.

An example of positive outcomes is the chronic objective pulmonary disease (COPD) remote monitor system. Propeller Digital Pulmonary Care solution includes a connected inhaler sensor that tracks and monitors inhaler usage, a mobile app with tips about asthma and COPD, and support from clinicians from Pulmonary Therapeutic Resource Centers.

Jenne said that before Evernorth launched the digital health formulary, they conducted a pilot with Propeller to understand how the solution would work for their clients. They found that asthma and COPD patients experienced a 45% increase in days without rescue inhaler use.

“This means patients have improved disease control and fewer exasperation,” she said. “The remote monitoring allowed patients to more easily track and monitor their rescue events, and over time to learn more about their triggers. The sensor syncs wirelessly to their phone so when the patient uses their rescue inhaler dispenser, it will trigger the app to appear for the patient to record the details of the event.

“Finally, the pulmonary therapeutic resource center pharmacist can use that data to determine if a patient is well controlled, or not well controlled and reach out to the patient to provide real time education and clinical support,” Jenne said.

The company recently launched four pilots within a digital health formulary. These include Jasper Health’s oncology support program, Zerigo for psoriasis and eczema, Hinge Health for women’s pelvic health, and Lid Sync for medication treatment adherence.