The Evernorth Digital Health Formulary & the Disruption of the Digital Health Payment Model


By JESSICA DaMASSA, WTF HEALTH

Last December, Express Scripts — now a part of Evernorth — became the first PBM to go to market with a digital health formulary. Basically, adapting the vetting, organizing, and pricing functions of a traditional medication formulary to the digital (health) age. Mark Bini, Chief Patient Experience Officer, spearheaded the effort, meant to alleviate the burden faced by Evernorth’s clientbase of 4,000 employers and health plans, who’s HR benefits teams want to make digital health solutions available to the 100+ million members of their health plans, but don’t have a frictionless, repeatable way to do so. As Mark puts it, “if you’ve seen one digital health startup, you’ve seen one.” And, for an HR benefits administrator whose inbox is inundated by digital health companies, the challenge of dealing with different levels of clinical validation, different data needs, different contracts, and, probably, most frustrating, different payment models that are often separated from their health benefit and pharmacy benefits, Evernorth’s Digital Health Formulary eases a real burden. So, a year in… how’s it going? Have Evernorth’s clients bought into more digital health solutions as a result of the formulary? What’s uptake been like among the populations they manage? And, how has this been working out for digital health startups? Mark gives us an update, talks through the details of the selection process, AND reveals what he’s got planned next. Spoiler: The evolution of the Formulary means adding more cohorts of digital health solutions more frequently, increasing the number of digital health solutions covered under drug benefits, getting a beat on longitudinal digital health engagement, and working out how to help consumers navigate all the various health tech options that are available to them.

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