The Digital Therapeutics Alliance is developing a payer-specific "framework for healthcare decision makers … to better understand, evaluate, and implement digital therapeutics."
For payers who want to learn more about emerging, technology-based treatments, the Digital Therapeutics Alliance (DTA) is an aggregated source for news and guidance. The nonprofit trade association’s primary role is to provide health plans, as well as "patients, clinicians, … and policymakers with the necessary tools to evaluate and utilize" products in the digital therapeutics (DTx) space. The following summarizes DTA's current and forthcoming resources, plus recent innovations from association members.
1. Foundation documents. As a starting point, the DTA site library includes five "Foundational Documents" with DTx product oversight essentials for "safety, efficacy, quality, patient centricity, privacy, and ongoing clinical impact":
- DTx Definition & Core Principles
- Industry Code of Ethics
- Industry Best Practices
- DTx Product Categorization
- DTx Product Quality & Access Worksheet
2. Coding changes. DTA CEO Andy Molnar states that "reimbursement remains [a] big issue" in the DTx field. This makes reimbursement design critical, including industry coding changes. Beginning in 2023, select CPT code updates will make it easier for physicians to be “reimbursed for their time spent prescribing, monitoring, and supplying online CBT [cognitive behavioral therapy] technologies."
3. A government-payer first. While DTA reports that "Medicare and Medicaid … are still working to determine how to formally recognize and provide patients with access to DTx products," one company is leading the way. Pear Therapeutics has become the first DTx vendor to partner with a state Medicaid agency for product reimbursement. Pending government and funding approvals, MassHealth will cover Pear’s reSET and reSET-O, two prescription DTx (PDT) products for substance and opioid use disorders.
4. Reimbursement innovation. Pear is one of several companies pioneering DTx and PDT reimbursement through PBMs. It has partnered with at least three PBMs—OptumRx, RemedyOne, and Prime Therapeutics—with the Prime partnership including a value-based contracting component. Big Health, which offers its Sleepio and Daylight DTx products for insomnia and anxiety, has created a unique PBM strategy with CVS Caremark.
5. Forthcoming payer guidance. DTA reports that it is developing a payer-specific "framework for healthcare decision makers … to better understand, evaluate, and implement digital therapeutics."
Laura Beerman is a contributing writer for HealthLeaders.