Express Scripts Formulary for “Digital Health” Offers Long Overdue Info

In mid-May, Express Scripts announced that it plans to introduce what it says is the healthcare industry’s first stand-alone digital health formulary. This may not sound like much, but I’d argue that it’s a noteworthy development. After all, Express Scripts is a Cigna company now, which makes this notice interesting from both a health plan and a provider standpoint.

In its recent press release, the vendor said it was creating the new formulary to help consumers and payers sift through the hundreds of thousands of personal health technologies and interventions available. As with pharma formularies, it’s also intended to help payers identify safe, effective and usable digital health tools.

The formulary, which will be available in 2020, will be a curated list of technology- and software-enabled applications and devices intended to prevent, manage or treat a medical condition. When it launches, the formulary will offer tools to manage diabetes, cardiovascular, behavioral health and pulmonary conditions, and will include tools for treating other chronic and complex conditions over time.

To create the formulary, Express Scripts says, it plans to develop a research process run by physicians, pharmacists and experts in health research and user experience. This team will look at the clinical outcomes associated with a given digital health solution, as well as therapeutic benefit data to decide which devices make the cut.

Express Scripts says that the digital health formulary will help reduce the administrative burden plan sponsors face when contracting with or managing digital health companies, along with providing a pathway to cover the growing list of prescription-only digital therapeutics coming to market.

There’s a lot to unpack here, but in the interests of keeping things readable, I’ll single out just a few items:

  • If this approach works, have no doubt that other intermediaries will follow the lead set by Express Scripts and create their own digital health formulary. The truth is that creating something like this is long overdue.
  • Digital therapeutics are a black box for many of us, but they’re a central preoccupation for biopharma companies. Making it easier for providers to prescribe these kinds of devices is likely to be a huge win for them.
  • This approach begs the question of whether tech investment and leasing can be managed effectively by the formulary approach. After all, doesn’t the implementation of such a formulary take away from or even bypass the decision-making process by which healthcare providers pick such devices?

The bottom line here is that while the Express Scripts announcement is worth a quick skim, the trends it hints at are likely to be a big deal going forward. Let’s keep our eye on this stuff people!

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.