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Prescription Digital Therapeutics: Coverage and Reimbursement


Steven Peskin, MD, MBA, FACP, shares perspective on factors that need to be considered by payers when making decisions about how to cover and reimburse for prescription digital therapeutics used to manage behavior-driven conditions.

Megan Coder, PharmD, MBA:I once had a company representative come up to me who—not a digital therapeutic—and say, “Oh, it’s just the smile on the patient’s face that matters at the end of the day.” I asked about security, privacy, the clinical evaluation, the random controlled trials, FDA clearance, etc. He responded, “You don’t need that.” As a result, I realized he was not going to be a digital therapeutic. From a payer perspective, what requirements are you looking at before you say yes, I want to put money behind this and I want to take risks and use this for my patients?

Steven Peskin, MD, MBA, FACP: We’re looking at it on several levels. One, we have our own behavioral health, which we took in house. Additionally, we have several physicians—we have an entire team—that are now part of Horizon Blue Cross Blue Shield, as opposed to using a third party, with what is called a managed behavioral health care organization. Overall, we’re looking at many options, whether it’s Eleanor Health or Mindoula Health. We also work with Quartet Health and several others.

There are several that I would call enhancers, such as telemedicine and telehealth, which is different from digital therapeutics. Therefore, my colleagues and I are constantly scanning the environment within behavioral health. In physical health we also have an investment arm, and we look at making investments in these types of companies. I heard a presentation by an individual from Blue Venture Fund. Coincidentally, she shared several behavioral health–related organizations, specifically some that are juxtaposed to digital therapeutics that the Blue Venture Fund is investing in.

Megan Coder, PharmD, MBA: This may be a more technical question—before we move back to the patient-provider space—but have you seen these covered under a specific benefit, whether it’s pharmacy or medical or even value-based contracting? Have you seen anything starting to emerge in terms of these different types of digital therapeutics?

Steven Peskin, MD, MBA, FACP: Some of our partners are adopting digital therapeutic-type innovations with the cost on their nickel. Our partners are in a value-based model, so they’re saying that this is worth it for us to invest in because we’re looking at how it can affect total cost of care and total medical expense. We’ll evaluate any digital therapeutic just as we evaluate any technology, such as a new surgical device. A friend of mine is working on a wearable technology from MIT [Massachusetts Institute of Technology]. If it holds up, it will have at least as good an impact on insomnia as Ambien, maybe better.

We’ll be looking at digital therapeutics the same way we look at everything, specifically on grounds of evidence, FDA approval, or what other authoritative organizations are saying, such as the American Psychiatric Association. We’ll approach digital therapeutics the way we approach a new cancer drug, a new medical device, or something new in wound care.

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