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PDTs in Behavior-Driven Conditions


Prescription digital therapeutics (PDTs) are explored in behavior-driven conditions, such as substance abuse disorders.

Megan Coder, Pharm.D, M.B.A.: Hello, and welcome to this Managed Healthcare Executive® Population Health Perspectives® titled “The Expansion of Prescription Digital Therapeutics in Health Care.” My name is Megan Coder, the chief policy officer at Digital Therapeutics Alliance [in Arlington, Virginia]. Joining me in this discussion are Paul Jeffrey, principal at Jeffrey Consulting [in Hingham, Massachusetts]; Eric Cannon, chief pharmacy officer at SelectHealth and general manager at Scripius [in Salt Lake City, Utah]; and Dr. Arwen Podesta, the owner of Podesta Wellness [in New Orleans, Louisiana]. We’re going to be talking about several topics pertaining to digital therapeutics, including the classifications of prescription digital therapeutics [PDTs], the utilization and coverage of these products in behavior-driven disorders and addressing potential barriers. There are many types of digital therapeutics on the market, ranging from nonprescription to prescription products, but we’ll be primarily focusing on products that require a prescription from a qualified clinician. Let’s get started.

Arwen, I’d love to get a sense from you in terms of digital therapeutics and the types of products you’re aware of that are looking at treating behavior-driven disorders such as insomnia, opioid use disorder and substance use disorder.

Arwen Podesta, M.D.: I was an early adopter [of using PDTs]. I’ve been treating substance use disorder for many years. We have a lot of access barriers and adherence barriers to that, so anything that can add value to my patient’s adherence, success and sobriety also can keep them from overdosing and keep me from losing sleep at night. That sounds selfish, but it’s part of the treatment world. The first to launch and [the first] that I began using was called reSET and reSET-O. Those are both for substance use disorder. reSET is for general substance use disorder, not alcohol solely, and reSET-O is for opioid use disorder, which is a major epidemic and a crisis among communities and patients. Those have been a great extender of my care, an addition that also helps a ton with retention for most of my patients who use them. Retention means better success rates, which means fewer overdoses and saving lives.

I treat a variety of things. I’m not just a substance use disorder specialist. I’m a psychiatrist, and I do a lot of wellness-based treatment like cognitive enhancement, trying to get patients optimized in a lot of capacities. Sleep is a huge problem, especially in the past couple of years, with schedules being bizarre and individuals working from home [during the pandemic]. One [treatment] is called Somryst, which is a prescription digital therapeutic for sleep. It’s phenomenal. All these things work when you use them and when the clinician uses them. Somryst has been wildly successful to help me have an extension rather than wait for a sleep therapist to become available, or someone who’s board certified in cognitive behavioral therapy for insomnia and who has that specialty. We can use this app, and the patient and I can address some of their sleep needs. There are others that I have my eye on that I haven’t started using for ADHD [attention-deficit/hyperactivity disorder], PTSD [post-traumatic stress disorder], migraines and other attention impairments. I’m very excited about the extender of using digital therapeutics, particularly prescription digital therapeutics, with all the evidence they have coming down the pipeline for so many behavioral health and mental health disorders.

Megan Coder, Pharm.D, M.B.A.: That’s encouraging to hear, especially in your work as a physician and psychiatrist. It sounds as if cognitive behavioral therapy is critical to the work you’ve been doing then, and how that relates to which digital therapeutics are able to help extend your care into patient’s lives than it sounds like.

Arwen Podesta, M.D.: That’s correct. Cognitive behavioral therapy has been studied. It’s the most studied type of therapy and has the most evidence. There are other therapies—some are more fluid, maybe less algorithmic—but this is the 1 that hits home the evidence of the successes. It’s easy for a digital therapeutic to algorithmize. It’s easy for patients to use and to stick and integrate into their life and behavioral change, and that’s what we need in a lot of these mental health disorders and differences. It’s a huge factor. Lately, I’ve had several patients I was trying to refer to therapists and cognitive behavioral therapy for depression, anxiety or obsessive-compulsive disorder, and none of the therapists I usually work with is taking new patients. As you can imagine, everyone is full. The mental health world is oversaturated with need. But we have digital therapeutics available for certain disorders. I’m using ones for sleep and substance use disorders, but we are looking at ones in the pipeline for all these other mental health needs. It’s a phenomenal advancement.

Megan Coder, Pharm.D, M.B.A.: That’s encouraging. Thank you for sharing that perspective.

Transcript edited for clarity.

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