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Jeffrey Dunn on Prescription Digital Therapeutics | 2022 PBMI Annual National Conference

Article

Payers are beginning to face fork-in-the-road coverage decisions when it comes to prescription digital therapeutics. So how will prescription digital therapeutics be covered? Under the pharmacy benefit or under medical one?

Jeffrey Dunn is betting on the pharmacy benefit.

“I think they are more likely to be covered under the pharmacy benefit,” Dunn said in a video recorded with Managed Healthcare Executive® in preparation for the 2022 PBMI Annual National Conference that starts today in Orlando, Florida, where he participated in a panel discussion on digital therapeutics.

“They require a prescription,” Dunn noted. “We have point-of-sale adjudication under the pharmacy benefit. We don’t have point of sale adjudication under the medical benefit. So we can manage prescriptions, we can manage quantity limits, we can look at utilization and adherence.”

Dunn also observed that there are rebates “in the space,” and that rebates are available under the pharmacy benefit not the medical benefit.

Dunn said he expects prescription digital therapeutics for Medicare beneficiaries to be paid for through Part D not Part B.

Dunn also discussed rebates in the interview. Rebates are a factor in the net price of prescription digital therapeutics, he told MHE, and they will influence coverage and tiering.

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