Digital Health Formulary: A Foundation for the Future of Pharmacy

Payers can now ensure the safety, effectiveness and usability of digital health technology tools made available to their members.
Digital Health Formulary

We are in an exciting age when technology is giving people 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.

With more than 300,000 health applications in the market, it’s easy to understand that clients and their members could potentially waste time and resources when selecting which tools to use.

The First Digital Health Formulary

To make it simpler for consumers and payers to navigate the enormous amount of currently available personal health technologies and interventions, Express Scripts will introduce the industry’s first, stand-alone Digital Health Formulary.

We see a need to put mechanisms in place to help carefully manage these innovations, and are proud to lead again by being the first health services organization to establish a formulary of this nature. The Digital Health Formulary will help ensure developers do right by payers and consumers, while increasing patient access to technology that can help improve their health.

The Digital Health Formulary will help payers ensure the safety, effectiveness and usability of digital health technology tools made available to their members. Available in 2020, the Digital Health Formulary will include technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition.

Similar to a medication formulary, Express Scripts will employ a comprehensive 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 Digital Health Formulary.

Each digital solution included on the formulary first must demonstrate therapeutic value, effective usability, and stringent security and privacy standards, followed by cost effectiveness.

With the Digital Health Formulary, plan sponsors can confidently 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
  • Help improve affordability by leveraging Express Scripts’ size and scale in the purchasing of digital health products, and
  • Create a pathway to cover the increasing number of prescription-only digital therapeutics that are coming to market.

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

Clients still will have the ability to choose which digital solutions they provide or cover for their members; inclusion on the Digital Health Formulary will not guarantee that a plan will cover a certain technology.

The Digital Health Landscape

Digital health technology includes software-driven tools that help patients take better control of their health. The marketplace is broad and growing exponentially, and includes tools that promote fitness, wellness and the prevention of chronic conditions, mobile health interventions, telehealth solutions, remote monitoring devices, and FDA-approved digital therapeutics that work with specific medications or medical devices. While the majority of apps and tools are available to all people, some require a prescription from a physician. The number of prescribed digital health products is expected to grow in the coming years.

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. 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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