ESI Launches Digital Health Formulary

In December 2019, Express Scripts (ESI) announced the launch of their Digital Health Formulary, which went into effect January 1, 2020.  To develop the formulary and choose which products to include, ESI reviewed clinical research, evaluated member experience and product usability, and analyzed the financial value of each product.

ESI lists the following as their Digital Health Formulary:

DHF-Approved-Vendors

As apparent in the chart above, the number of on-formulary products is limited.  Those included only treat a small range of diseases including diabetes, cardiovascular, pulmonary, and mental health conditions.  Noticeably absent from the formulary are several high-profile digital health products, specifically those mentioned on the Digital Therapeutics Alliance (DTA) website.

The DTA is a trade association with a mission to “broaden the understanding, adoption, and integration of clinically-evaluated digital therapeutics into healthcare through education, advocacy, and research.”  The organization established digital therapeutics foundational principals and Industry Core Principles.  DTA members include Bayer, American Association of Diabetes Educators, Boehringer Ingelheim, Headspace, Otsuka, Novartis, Sanofi, and other.  Members have developed products aligning with the Industry Core Principles, and case studies for these products are published on their website.  Products include WellDoc’s BlueStar, Voluntis’ Insulia, and Propeller Health’s Propeller.  Of these three digital therapeutic products, only one, Propeller Health, is included on the ESI Digital Health Formulary.  Other digital therapeutic products notably absent from the ESI formulary include Pear Therapeutics’ reSET and reSET-O, intended to treat Substance Use Disorder (SUD) and Opioid Use Disorder (OUD), respectively.

The publication of ESI’s Digital Health Formulary raises as many questions as it answers.

  • What were the specific reasons why the limited products were approved?
  • What other products were evaluated but not included?
  • If products were not placed on the formulary, were the reasons primarily clinical, humanistic, or financial?
  • Will ESI eventually publish a Digital Health Exclusion list similar to their Formulary Drug Exclusion List?
  • What is the expected growth rate of the Digital Health Formulary and how many products will be evaluated and/or added in 2020?
  • How will other PBMs react to this Digital Health Formulary and is this something we should expect to see from CVS Caremark and OptumRx in the future?

While the answers to these questions are not yet known, a major payer’s publication of a Digital Health Formulary clearly indicates a shifting industry mindset.  Obtaining formulary coverage for digital health products is just the first hurdle in the market.  With coverage now available for some digital therapeutic products, it is more important than ever that manufacturers have their products accurately listed in the drug compendia databases to enable physician e-prescribing and ordering through EMRs and EHRs.

PHSL offers a full range of drug compendia services and is experienced in evaluating digital health product labeling and assisting manufacturers with getting their products accurately listed in the drug compendia systems.  If payer coverage is the first hurdle, EHR listings and e-prescribing are the second hurdle in product uptake.  PHSL is well situated to address these hurdles and help providers of digital health products.  Let us know how we can assist your company in meeting your digital health goals!

 

Posted January 2020

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