About eight month after its unveiling, Express Scripts has now revealed the companies and programs it is including in the inaugural cohort of its digital health formulary — the first such resource from a pharmacy benefits manager designed to help clients review vetted digital health programs.
The formulary is comprised of 15 clinically validated digital health programs addressing the management of diabetes, prediabetes, hypertension, asthma, COPD, depression, anxiety and insomnia. These services, designated as either a preferred or alternative option, come from Livongo, Omada Health, LifeScan (powered by Welldoc), Propeller Health, Learn to Live and SilverCloud Health.
“This first cohort in particular we wanted to focus on diseases states that are ultimately driving spend in the categories that are affecting our clients, but also areas where patients are living with complex conditions where digital health solutions can help them live healthier and simpler lives,” Mark Bini, VP of innovation and member experience at Express Scripts, told MobiHealthNews.
Bini said that these digital health companies were selected from more than 70 that were reviewed on the strength of their collective clinical research, usability and financial value, in that order. But even that collection of candidates only came to be after the PBM received a “flood of interest” from hundreds of companies after the May announcement, he said.
“Whittling that down wasn’t actually as cumbersome as you might have thought, because we knew what categories we wanted to launch the solution in for the initial cohort, so that helped us narrow down the field,” Bini said. “And what we find is while we see a tremendous number of early stage companies coming to the market, in order to do business with Express Scripts at the scale of our digital health formulary, companies have to have the appropriate privacy and security standards in place. And a lot of the early stage companies just aren’t there yet, [although] they have pathways to it. But that also helps us hone in on the companies that are truly ready to scale, be clinically effective for our clients and patients, [and can] ensure that they are protecting the data that we use to launch these solutions.”
For Propeller Health, this process was a little bit different. CCO Chris Hogg told MobiHealthNews that the digital respiratory health company’s prior partnership with Express Scripts on deployments of its inhaler sensor products had already provided the PBM with an idea of Propeller’s base level practices.
“We’ve been working with Express Scripts for a few years on different programs and pilots, and so we’ve already undergone their clinical vetting, privacy audits and all of that,” Chris Hogg, CCO of Propeller Health, told MobiHealthNews. “We did talk with them about being included, but … It was probably a little bit easier on us because we had already gone through some of their processes.”
Bini said that Express Scripts will begin working to expand the resource in 2020. These additions will tackle the clinical categories broached by the formulary’s initial cohort, as well as other high-cost areas such as musculoskeletal conditions, inflammatory conditions, oncology and women’s health that he said are well served by the strengths of digital health management programs.
WHAT’S THE IMPACT
The participating digital health companies and Express Scripts alike told MobiHealthNews that they view the formulary as a valuable resource, regardless of their role in the process.
“This is a win-win-win for the industry,” Bini said. “It’s a win for patients who will benefit from the solutions that can ultimately make them healthier and make them live simpler lives. It’s a win for our plan sponsors, because they need to have the confidence that when they invest in a digital health solution that it’s going to actually work and provide value and return for that investment. And it’s a win for digital health industry because … we’ve created a pathway for these digital health companies to create innovative and value-added solutions that can change people’s lives.”
Hogg agreed with Bini on the benefits a vetted formulary could bring to the broader digital health industry.
“I think one of the big challenges to digital health to date is that there aren’t avenues for traditional reimbursement and distribution like there are for other products, like med tech products and pharmaceutical products,” he said. “So, we [at Propeller Health] believe this is a really good step in the process of making digital health and digital therapeutics more traditional in terms of reimbursement and distribution. For us, we view this as a mechanism to provide access and reimbursement for many more patients, for a product that we have clinically validated.”
Express Scripts, meanwhile, benefits by collecting compensation for the digital services provided to clients, and by providing an enticing offering that will satisfy both existing and new customers. He also highlighted the data collection capabilities of digital offerings, which he said could be combined with pharmacy operations.
“We work with these digital health companies, and their solutions [to] integrate their data into our platform so that we can augment the care that our specialist pharmacists provide to our patients,” he said. “We believe our pharmacists are well equipped to be able to have oversight over digital health solutions because we’re the most used benefit, we have the most interactions with patients. So, when pharmacists can leverage data like blood sugar data or inhaler use data, it allows us to combine all that with our claims data both pharmacy and medical to ensure that patients are living healthier lives, but also to remotely monitor them when they might have exacerbation of a particular condition.”
THE LARGER TREND
Express Scripts’ first announcement last spring was followed shortly after word from CVS Health of its own service aimed at helping clients roll out and manage third-party health products. While applicable to both digital and non-digital products, the competing PBM decided to kick off the program by announcing sleep app maker Big Health as the service’s first participating vendor.
Both initiatives were well received by the digital health community, with Digital Therapeutics Alliance executive director Megan Coder telling MobiHealthNews that the next step is to unify the metrics and credentials PBMs and other are seeking when validating these products.
“I hope that when groups like Express Scripts and CVS move forward that they do look at what the industry has already put together,” Coder told MobiHealthNews back in July. “We have a really broad group of companies that came together to help define this space and define some best practices. And also important to note is that our membership is international in scope, so we’re really trying to ensure that we have international perspective, recognizing that the products should be of the same level of quality and rigor regardless of where they are developed or used by patients.”
ON THE RECORD
“The next era of healthcare will be defined by digital care that empowers patients while delivering both clinical and financial outcomes,” Omada Health CCO Wei-Li Shao said in a statement. “The launch of Express Scripts’ Digital Health Formulary will provide a new channel where employers will discover first hand which solutions deliver the best results for their populations. It’s a space in which we are excited not only to compete, but to demonstrate our value for our participants, and for our partners.”