Express Scripts plans formulary for apps, medical devices

By | May 20, 2019

Dive Brief:

  • Pharmacy benefit manager Express Scripts is launching a digital health formulary next year: a list of digital health tools, including smartphone apps and software-enabled medical devices, to help patients manage their health. Express Scripts clients will still be able to choose which digital tools they provide for their members.
  • Physicians, pharmacists and other health research professionals will curate the formulary list by reviewing clinical outcomes and therapeutic benefit data, and will also take into account a digital service’s security, privacy and cost-effectiveness, according to the PBM giant.
  • Express Scripts wants the formulary to reduce administrative burden for plans by cutting the time associated with managing digital health companies, lower costs through bulk purchasing of digital health products and create a smoother way to cover increasing demand for prescription-only digital therapeutics.

Dive Insight:

The digital health landscape continues to expand in breadth and volume, and traditional players across the board are looking for ways to leverage these emerging technologies to improve quality of care for patients and lower their own costs.

“Much of this technology is still emerging, and there are many digital health solutions that require clinical review and validation,” Mark Bini, Express Scripts VP of innovation and member experience, said in a statement. “We see a need to put mechanisms in place to help carefully manage these innovations.”

The popularity of wearable technology in health is one example, with Fitbit and Apple Watch touting their technologies’ abilities to track the everyday wellness of their users. CVS-owned Aetna bought in earlier this month, launching an app for Apple Watch combining wearable and claims data that can be bought as a plan benefit.

The PBM says its new formulary will include digital health solutions for a host of chronic and complex conditions, including diabetes, cardiovascular, pulmonary and behavioral health issues.

Express Scripts was snapped up by Cigna in a $ 67 billion deal finalized late last year amidst a flurry of anticompetitive concerns. Cigna has previously signaled interest in tackling the high costs of diabetes care, announcing in early April its members will pay no more than a $ 25 copay for a 30-day supply of insulin, a small dip from diabetic patient out-of-pocket payments last year.

Cigna is coming off a strong fiscal first quarter thanks in part to its acquisition of Express Scripts, although it’s not clear how much bringing the PBM behemoth into the fold contributed to its strong performance.

PBMs, which profit from a share of the rebates they negotiate for lowering the list prices of drugs, have been the frequent target of ire from policymakers.

HHS floated a proposal earlier this year to restrict rebates, sparking immediate uproar from the payer/PBM community. The February proposed rule, if finalized, would limit drugmaker rebates to PBMs in Medicaid managed care organizations and Medicare Part D, moving them instead to point-of-sale discounts for beneficiaries.

And CMS targeted the practice of PBM spread pricing this month, releasing guidance that would limit spread pricing’s influence on a plan’s medical loss ratio.

Filed Under: Health IT Payer

Top image credit: Express Scripts Holding Co.

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