Express Scripts to launch digital health formulary for payers, patients

senior with digital health
Express Scripts plans to launch the industry's first digital health formulary to help consumers and payers navigate the hundreds of thousands of digital health tools available. (Sladic/Getty Images)

The digital health market continues to grow exponentially with apps that promote fitness, wellness and the prevention of chronic conditions as well as telehealth solutions and remote monitoring tools. But currently, there is no standard way to validate the hundreds of thousands of digital tools available.

Pharmacy benefits manager Express Scripts, now owned by Cigna, is taking one approach by launching the industry's first digital health formulary. Similar to a medication formulary, the digital health formulary will be a curated list of technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition with the aim of helping payers and consumers navigate the growing number of digital health tools, the company said in a press release.

The formulary will be available in 2020.

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“We are in an exciting age when technology is giving people even greater control of their own health and well-being. However, much of this technology is still emerging, and there are many digital health solutions that require clinical review and validation,” Mark Bini, vice president for innovation and member experience at Express Scripts, said in a statement.

RELATED: Patients with the most to gain from digital health hardly engage with new tools

“We see a need to put mechanisms in place to help carefully manage these innovations," Bini said. "This formulary will help ensure developers do right by payers and consumers while increasing patient access to technology that can help improve their health.”

Express Scripts will use a process overseen by physicians, pharmacists and experts in health research and user experience who will review clinical outcomes and therapeutic benefit data to determine inclusion on the formulary, the company said. Each digital solution included on the formulary first must demonstrate therapeutic value, effective usability and stringent security and privacy standards, followed by cost-effectiveness, according to Express Scripts.

Initially, the digital health formulary will include solutions for diabetes, cardiovascular health, behavioral health and pulmonary conditions, and will later expand to include tools for other chronic and complex conditions.

Many industry stakeholders have recognized the need for an objective way to measure the value of digital health technology. There have been ongoing discussions about how to assess the validity of technology tools and separate hype from reality. 

This week, researchers from John Hopkins University called for the development of a "digital health scorecard" in a paper published in Nature. The scorecard would be a "multi-stakeholder approach that objectively and rigorously evaluates solutions" based on four criteria: technical accuracy, clinical value, usability and cost. “For digital health solutions to have greater impact, quality and value must be easier to distinguish,” the researchers wrote.

RELATED: WHO releases 10 recommendations on digital health interventions to improve care

Express Scripts' digital health formulary is one approach, and the company said the formulary will help plan sponsors deploy a digital health product to their members knowing it has been through a uniform review process to ensure its safety, quality, usability and affordability.

The digital health formulary also will reduce the administrative burden for plan sponsors associated with contracting and managing digital health companies, the company said, and help improve affordability by leveraging Express Scripts’ size and scale in the purchasing of digital health products.

Further, the formulary will help create a pathway to cover the increasing number of prescription-only digital therapeutics that are coming to market, a segment of the digital health market that is expected to grow.

“In addition to helping payers manage currently available digital health solutions, our digital health formulary lays the groundwork to manage new solutions and tools that have yet to be invented,” said Bini. “We want to create a level playing field for inventors and entrepreneurs to encourage continued innovation in this space, and to ensure a pathway to deliver those innovations to patients with assured safety, accuracy, and affordability.”

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