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Prescription Digital Therapeutics in Behavior-Driven Conditions EP2


Clinicians, a pharmacist, and a payer discuss their current experience with prescription digital therapeutics for behavior-driven conditions and share considerations for expanding on their use in clinical practice.

Megan Coder, PharmD, MBA: Welcome, we are glad to have you participate today in a roundtable discussion on prescription-based digital therapeutics in behavior-driven conditions. Today’s faculty will include 3 distinguished members: Dr John Luo, a physician and clinical professor of psychiatry at University of California, Irvine; Dr Steven Peskin, the executive director of population health and transformation at Horizon Blue Cross Blue Shield of New Jersey, and an associate clinical professor at Rutgers University; and Dr Nidal Moukaddam, an associate professor at Baylor College of Medicine. The objective today for this multistakeholder roundtable aims to provide audiences with the education they need for digital therapeutics, specifically those provided to patients by physicians via prescription.

We’ll also be dealing with more of an in-depth analysis on the optimal use and benefits of these products. To set the stage, it may be helpful to describe more of what we’re speaking on regarding digital therapeutics.

In comparison to other digital health products on the market, such as wellness and fitness apps, diagnostic tools, or even medication adherence apps, digital therapeutics use software to deliver a clinical grade medical intervention to a patient. Specifically, it is used to prevent, manage, or treat a wide variety of diseases or disorders. Since digital therapeutics address such a wide variety of conditions, from diabetes and asthma, to insomnia and substance abuse disorders, it’s important that they adhere to core principles in the industry. These principles relate to clinical evaluation, rigorous product design, human factors testing, patient privacy, security, and regulatory oversight.

Our focus today will be on those products that are being used by a patient in the context of care that is delivered to them via a formal prescription from their clinician. Now, I welcome all the panelists to our discussion. Let’s open the floor to get a sense of your experience with digital therapeutics. Dr Luo let’s start with you for a quick introduction on your area of interest in this space.

John Luo, MD: I’ve been using technology in psychiatric practice for almost 20 years. I started off with the PalmPilot, which at the time wasn’t patient facing, it was for providers. I’ve really seen a change, where nowadays via a smartphone patient pick up apps and they ask the provider, “Hey, is this something useful?” or they are just starting to use it on their own. From personal experience, I haven’t prescribed them, per se. I’ve recommended a few apps, especially for patients with metabolic [adverse] effects from their medication. Specifically, I recommend certain apps for calorie tracking or exercise tracking to help them in their weight loss management plan. For patients who need anxiety and depression therapy, many of these apps are very applicable, especially apps that help with mediation or mindfulness. I think there’s a huge uptake in interest in these, especially in the current health situation.

Megan Coder, PharmD, MBA: Dr Moukaddam, I’d be interested to hear your perspective in this area.

Nidal Moukaddam, MD, PhD: The health ecosystem is very ripe for us to use apps. Apps can be thought of as being clinician driven or patient driven. In this case, we want to focus on the clinicians prescribing the apps or recommending apps, because when a patient picks an app, it’s not necessarily for the right problem or the right solution for whatever they think the problem is. Therefore, it is important to take the clinician’s perspective in this. My interest in technology is both clinical and research. I collaborate with the School of Engineering at Rice University, and we develop applications for clinicians, and we try to study that perspective. I take the clinician’s side and try to give clinicians their wish list in terms of therapeutics.

Megan Coder, PharmD, MBA: Dr Peskin?

Steven Peskin, MD, MBA, FACP: Digital therapeutics, in kind of a subset, we had a meteoric rise in telemedicine and telehealth, which I know is not what you’re asking about in terms of digital therapeutics. There is an adjacency and juxtaposition of digital health, broadly speaking. We don’t have any payment practices that I’m aware of that specifically reimburse for a digital therapeutic. We have a tremendous amount going on in digital health, including the juxtaposition with a group called Eleanor Health that we work with that is using some digital therapeutics in their approach to substance use disorder. We certainly have some of our clinical partners who have taken it upon themselves to initiate programs and tech space applications or messaging.

Another example of where digital therapeutics or digital management are being used is in distress screening and cancer care, which obviously has significant behavioral overtones to it. We’re very sanguine about this area. We’ve had a lot of focus in expanding our efforts in telemedicine, especially in behavioral health, and have seen that to be tremendously valuable in getting better access to people in need of behavioral health. The actual digital therapeutic itself—application-based or tech space, or for that matter an iPad or tablet or computer-based digital therapeutic—is something we’re very sanguine about, but it has yet to come into the mainstream as far as the payer is concerned.

Megan Coder, PharmD, MBA: Thank you for that perspective. We’ll loop back to some more of those notions too, as we carry on with today’s discussion.

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