Formulary guidance and transparency from P&T to point of care

Radar On Market Access: Express Scripts Takes on Industry's Digital Transformation

Posted by Judy Packer Tursman on May 30, 2019


Cigna Corp.'s Express Script PBM expects to introduce the industry's first stand-alone "digital health formulary" in 2020, the company said May 16. It intends to use a uniform review process to ensure the safety and quality of apps and devices on the market for diabetes, cardiovascular and pulmonary conditions and behavioral health, AIS Health reported.

By creating a digital formulary, Express Scripts "is using old hat methods to manage these new digital health solutions much like they do on brand and generic drugs or other therapies via utilization management," says Nathan Ray, senior principal in business consulting firm West Monroe Partners’ health care and life sciences practice.
"A formulary allows the administrator to steer demand and control reimbursement for the use of preferred solutions," Ray says. "Management via formulary has its upsides: It can reduce prices paid by payers and consumers."

Moreover, digital health might be only the first step as PBMs ask what else they can put through their channel, says Ashraf Shehata, a principal in KPMG's health care life sciences advisory practice and the firm's Global Healthcare Center of Excellence.

Dea Belazi, Pharm.D., president and CEO of AscellaHealth, says it makes sense to think of the formulary pharmacy and therapeutics process as a coordinated effort to evaluate the merits of drugs or technologies — or for broader applications.

Yet "at the end of the day, how is this any different than what they're doing today?" he asks. "Is there going to be an impact in either cost or outcomes in this new digital formulary process? Are numbers going to be different? It would be amazing" if there were improvements.

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Topics: Industry Trends, Data & Analytics, Provider, Payer