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Pharmacy benefits manager (PBM) Express Scripts is launching the first-ever digital health formulary — an extensive list that details digital health solutions available on the market — which should guide payers to bulk up health plans with tools that give them the highest return on investment possible.
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Express Scripts’ new tool will emulate the drug formularies that PBMs — middlemen of the pharmaceutical industry responsible for negotiating the costs of drugs for health plans — use to manage specialty drug costs, according to the Pharmaceutical Care Management Association.
Express Scripts’ formulary will be available in 2020 and will include solutions for diabetes, cardiovascular conditions, behavioral health, and pulmonary conditions, with plans to include digital health tools for other chronic conditions.
Here’s what it means: A digital health formulary should help payers in search of digital solutions navigate murky waters as the market becomes crowded with a web of new players.
- Payers are bullish on digital health solutions. A plethora of US insurers are betting on wearables and digital therapeutics to help keep members healthy, and 94% of private plans in the US offer virtual care services, per a new survey from America’s Health Insurance Plans. US payers have reason to ramp up innovative offerings for their members: Tools that can manage chronic conditions could help trim down costs, considering chronic conditions drive 90% of the $3 trillion the US spends on healthcare annually, per the CDC.
- But finding a digital health partner could be challenging in a market that’s swelling with new players — with little pointing toward their effectiveness. The number of digital health entrants flaunting new tools and services will likely spike in coming years as the global digital health market’s projected to hit $380 billion by 2024, growing 26% annually. This means that payers will likely have a wider range of options to choose from — but with little guidance, payers could choose products that aren’t effective. For example, mobile health apps are often advertised as functional health aids, but there’s little evidence of their clinical effectiveness. A formulary that discloses therapeutic value, usability, and cost effectiveness could help payers choose the products that’ll give them most bang for their buck.
The bigger picture: It’s likely we’ll see an upsurge of healthcare stakeholders pushing for regulatory oversight and guidance when it comes to digital health tech.
Consumer appetite for digital health tools is inflating, and tech-savvy millennials — who make up the majority the US adult population — will likely demand more digital offerings from their providers and payers. So, these stakeholders will need to find efficient ways to wade through the packed market. Just this week, medical researchers stressed the need to develop a "digital health scorecard" to evaluate new tech tools and suggested medical professionals team up with the FDA to set standards and assess efficacy, underscoring that navigating the abyss of health tech tools is a pain point for healthcare stakeholders.
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