Medical experts discuss the impact of health inequities on the optimization of prescription digital therapeutic usage.
Megan Coder, Pharm.D., M.B.A.: Eric and Paul, how have you seen these products—in Medicaid or in other practices—touch on some of these inequities, whether they’re geographic, language or cultural. I’m curious to see how you’re witnessing digital therapeutics impact some of these areas.
Eric Cannon, Pharm.D., FAMCP: When we look at health inequities, we’ve been using different applications to bridge some of those inequities, primarily around language. We still have a long way to go with some of the cultural barriers, but we can slowly break down some of them and instill a greater understanding with different populations by putting information in front of them in a way that engages them. I like that we have a lot of patients, especially if you look at our Medicaid population, for whom transportation is a real issue. It’s a real leap forward to be able to provide therapy, information, follow-up or tracking to individuals whom you’d normally ask to come back to the office. Even individuals for whom you wouldn’t think transportation is an issue, they’re taking time out of their day. There are a lot of those types of inequities. We’re just starting to scratch the surface, and some of this is adoption. As we get adoption, then we can start factoring in more ethnic and cultural types of differences in inequities. The tools have the ability to adjust and accommodate populations going forward.
Paul L. Jeffrey, Pharm.D.: As an aside, I once was asked the question, “What is the Medicaid program doing about health disparities.” That’s why we exist, in a way—not to be smug about it. The patients we serve are going to encounter many of the barriers that exist from the social determinants of health and other things. Transportation is a significant issue. We have standards of care relative to access to treatment providers. Some of them seem as if they might be simple. A pharmacy must be available within X number of miles. But if the member doesn’t have a car and there’s no bus route, then 5 miles is an insurmountable task for them. It’s highly valuable to have something that resides within the patient’s hands. The idea is that we can monitor it. The payer wouldn’t do this, but the provider would be able to monitor their use of that.
When we look at how patients adhere to their medications, we use a proxy. Did they get their prescription filled every 30 days or every 90 days for a 90-day supply? We have no idea whether they’re taking it or sharing it or putting it in a closet. But with the [prescription] digital therapeutic, the provider would know that there’s engagement with the product. The equitable distribution of the app—we would demand that in terms of our provider requirements. If they use an app for 1 patient, they need to be able to use that app for a Medicaid patient. It’s an equity requirement. We transitioned our Mass Health program to make sure we provide as much community-based care as we can. I see this as another tool in using community partners or other levels of caregivers to provide access to all the services we pay for in pharmacy deserts or rural areas. Massachusetts is not highly rural, but western Massachusetts is, so we take that into consideration.
When we were first evaluating the payer products, there was an obligation on the part of the digital therapeutics industry to make sure that the products they develop are culturally appropriate. With our investigation into health disparities, inclusion and things of that nature, my team began to evaluate the clinical trials that we use for adopting a drug and looking at the profiles of those involved in clinical trials. Do they look like the Medicaid population? If not, we’re going to look for other evidence that there may be differences in that population—for example, compared with the population that was used in the trial. When the payer products first came out, one of our first questions with my team but also from our larger team was: is it available in other languages? We’re still geared toward the English language, and the developers have to do as much as they possibly can to make sure the product they put into the marketplace will be useful to the entirety of the population for which it’s intended. In substance use disorder, that was critically important.
Transcript edited for clarity.