Home Health Care Express Scripts’ new formulary offers critical support for digital health startups

Express Scripts’ new formulary offers critical support for digital health startups

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Omada Health’s platform helps patients with hypertension and diabetes manage their conditions. The company was selected for Express Scripts’ first digital health formulary.

 

Express Scripts unveiled the details of its first digital health formulary on Thursday. The program, first announced by Cigna’s pharmacy benefit manager in May, gives the bustling field of health apps, digital therapeutics and remote monitoring devices a better chance at adoption.

It will also serve as a critical support to digital health startups, several of which have raised large funding rounds but struggle to gain the trust of insurers—and patients.

Express Scripts picked 15 programs from hundreds of submissions to include in its first release starting in January, 2020. They were evaluated based on three criteria:  clinical research, usability and financial value.

The selected solutions address a wide variety of common chronic health conditions, from diabetes, hypertension and asthma to anxiety and depression. They will integrate with Express Scripts’ pharmacy benefit, and patients will be able to receive support from the PBM’s pharmacists.

“It’s our job to find the right digital health solutions for our clients and patients, and then make sure patients use these solutions effectively,” Mark Bini, chief patient experience officer for Express Scripts, said in a news release.  “With the Express Scripts Digital Health Formulary, we’ve created more than just a list of approved programs or a vendor management process. We built a foundation for the future of care and pharmacy that will deliver better access, affordability, and health.”

The new formulary will make it much easier for employers to include digital health offerings in their plans, said Sean Duffy, co-founder and CEO of Omada Health. It will also give the selected companies a foothold in one of the largest PBMs, which manages prescription plans for more than 80 million members.

“The ability to lean on (Express Scripts) to serve as a conduit is pretty instrumental,” Duffy told MedCity News. “A big headwind for early companies commercializing digital health offerings is finding a way to gain access to employers.”

In particular, the new formulary will help digital health companies get a foothold in mid-sized companies, most of which don’t have the resources to choose and manage these tools.

For example, a 10,000-person employer would primarily work with the company’s health plan and PBM to come up with a benefits plan. Once they start adding additional services to that plan, they have to figure out how to integrate the different pieces, budget for them and perhaps add another internal partner to manage them.

“It adds a lot of administrative burden and complexity to add more to that world,” Duffy said.

San Francisco-based Omada Health will be included on the formulary for its diabetes prevention, diabetes management and hypertension management programs. The company has already enrolled more than 300,000 participants in its programs, and works with several major health plans.

“As we’re starting to see PBMs get into digital health space, we feel really confident about how we’re going to show up in this channel, and the value we can provide to these employers,” Duffy said.

On the behavioral health side, Boston-based SilverCloud Health will serve as one of Express Scripts’ providers. SilverCloud’s platform offers programs for anxiety and depression, two of the most common mental health conditions. It also offers access to online coaches, intended to help offset long wait times for mental health services.  The company has delivered treatment to 300,000 users to date.

“The solution will help Express Scripts execute on its mission of creating a better healthcare system by providing greater choice, predictability, affordability and improved outcomes,” SilverCloud CEO Ken Cahill said in a news release. “It also adds another effective tool for the company to utilize in its digital formulary, creating personalized solutions that make a meaningful difference for those covered by an Express Scripts plan and ultimately helping its members to live better, healthier lives.”

The full list of programs on the formulary includes:

  • Livongo for diabetes and hypertension
  • Omada Health for diabetes and hypertension
  • LifeScan’s OneTouch Reveal Plus for diabetes management
  • Propeller Health for managing asthma and chronic obstructive pulmonary disease
  • Learn to Live Cognitive Behavioral Therapy for depression, anxiety and insomnia
  • SilverCloud Health Cognitive Behavioral Therapy for depression, anxiety and insomnia

Photo credit: Omada Health

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