Industry-first Express Scripts Digital Health Formulary will allow employers and health plans to manage this fast-growing segment of health care while improving access for patients.

By: Mark Bini

Vice President, Innovation & Member Experience

As more people turn to digital programs to help manage serious illnesses and take better control of their health, Express Scripts is making it easier to connect consumers with the apps, devices and digital therapeutics that work best for them.

In May, we announced we were developing the first-ever formulary for digital health. Since then, we have been building this industry changing platform, establishing a four-stage formulary review and selection protocol and reviewing hundreds of submissions from digital health developers.

Now, we’ve established the first group of 15 clinically validated programs from leading digital health developers to be included in our first release starting in January 2020. We’ve set the bar high for clinical effectiveness, user experience and financial value for digital health solutions, while also combining coverage into the pharmacy benefit and providing patients with expert support from Express Scripts specialist pharmacists.

The First Cohort

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

These solutions engage with patients in a variety of ways, for example:

• allowing a pharmacist or nurse to remotely monitor a patient’s use of a drug therapy;
• synching with a diagnostic device that provides patients or their caregivers with vital information, like blood sugar or blood pressure, and alerts them to potential concerns;
• offering virtual personal coaching from a health or wellness professional; and
• providing virtual support from a patient’s peer.

Laying the Groundwork for the Future of Care

The Express Scripts Digital Health Formulary will do for the developing digital health care industry what our drug formularies have achieved for prescription medications for more than 20 years – access, choice and value for payers and patients.

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. 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.

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. 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. Research from the National Business Group on Health shows that half of employers anticipate digital health solutions having a very significant impact on their members. However, the digital health industry itself is still relatively new: a quarter of digital health companies have less than two years of experience.

Access + Clinical Support

Digital health care is creating a sea change for pharmacists, allowing them to expand their roles to counsel patients on how they can use a digital health product or program to achieve their health goals.

For example, in just one year, 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.

It’s our job to find the right digital health solutions for our clients and patients, and then make sure patients use these solutions effectively. With the Express Scripts Digital Health Formulary, we’ve created more than just a list of approved programs or a vendor management process. We built a foundation for the future of care and pharmacy that will deliver better access, affordability and health.