EP265: The What, the How, and the Questionable Why of Digital Therapeutic Formularies, With Randy Vogenberg, PhD

In this episode, Stacey Richter talks with Randy Vogenberg, PhD, principal at the Institute for Integrated Healthcare, about the what, the how, and the questionable why of digital therapeutic formularies. WHAT YOU'LL LEARN ✅ What a digital formulary actually is, and why PBMs are drawn to creating them ✅ Why the word "formulary" implies more than a technology assessment — it implies a promise of reimbursement ✅ Whether a third party disconnected from the care setting should be selecting which digital tools get used and paid for ✅ Why a more crowdsourced, bottom-up approach to digital health tool selection might work better ✅ What's standing in the way of resetting reimbursement for digital therapeutics WHY THIS MATTERS Randy Vogenberg questions whether digital therapeutic formularies, largely driven by PBMs, actually serve patients or mostly serve as a new revenue opportunity dressed up as market need. He argues that health care is fundamentally local and relationship-driven, which makes top-down technology selection a poor fit, and suggests that those who actually use digital tools — clinicians and patients — need a real seat at the table in deciding what gets adopted and reimbursed. The conversation surfaces just how many unresolved questions remain around cybersecurity, harm, and what's genuinely worthy of reimbursement in digital medicine. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 02:51 What a digital formulary is. 03:52 PBMs and digital formularies. 04:41 The changing landscape of PBMs and digital health. 06:00 The intersection of PBMs and digital health tools. 10:18 "Arbitrage, full on."—Mark Blum, from America's Agenda. 12:21 The inherent differences between a health plan and a PBM. 15:58 The original purpose of a pharmacy/therapeutics committee. 16:58 "There's a lot of change happening, is the bottom line." 18:18 The risk assessment behind medical software. 18:29 Harm vs digital therapeutics and digital medicine. 18:52 Cybersecurity in digital therapeutics. 19:08 Reimbursement in digital therapeutics. 19:43 The question of "how" in reimbursement. 20:37 "How do we reset health care in just one state, let alone the whole country?" 22:13 Taxpayers, patients, and employers vs the health care industry. 22:56 The slow move away from fee for service, and why. 24:13 The timeline for incorporating digital tools into the health care system. 24:33 "It's a real problem for the consumer side." 25:09 "What's really going to be worthy of reimbursement?" 25:50 "There's only two major payers in the health care system … that's the government, and it's the private sector employers and state programs or unions."