Pharmacy benefits manager Express Scripts, now a Cigna company, will introduce what its officials say is the industry's first stand-alone digital health formulary.
The new formulary will aim to help payers ensure the safety, effectiveness and usability of digital health technology tools made available to their members. It will become available in 2020, and will be a curated list of technology- and software-enabled applications and devices that help patients prevent, manage or treat a medical condition, according to company officials.
While the digital health marketplace is increasingly growing with tools that aim to help patients take better control of their health, some apps and tools are not available to everyone and require a prescription from a physician. This will likely lead to an increase in the number of prescribed digital health products over the next few years.
Similar to how a medication formulary works, Express Scripts will employ a process overseen by physicians, pharmacists, and health research and user experience experts, who will review clinical outcomes and therapeutic benefit data to determine inclusion on the 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, officials contend.
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, officials point out.
"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, innovation and member experience, Express Scripts, said in a statement. "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. This formulary will help ensure developers do right by payers and consumers, while increasing patient access to technology that can help improve their health."
Bini also added, “"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."
