Lack of Health Plan Coverage Leads to Diminished Access to Treatments for Patients


Prescription digital therapeutics (PDTs) are evidence-based medical interventions using software that can be accessed on a tablet or smartphone to prevent, manage, or treat a range of diseases and disorders. However, despite their medical benefits and convenience for patients, PDTs are not yet widely covered as a pharmacy benefit. A recent article in Politico Pro highlighted how health providers are struggling to prescribe PDTs due to the lack of available billing codes. The article noted that while some PDTs that have been approved by the Food and Drug Administration (FDA) are gaining coverage traction, other FDA-cleared PDTs are not. The article explains that this hesitancy from payers is the result of too many digital therapeutics in the field which has raised payer concerns for the effectiveness of some of these digital health apps or devices. Further, the article elaborates that as a result of a lack of coverage, health providers are subsequently less likely to prescribe the treatment as there is no way for the health provider to be reimbursed for their time. The full article can be read here.


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