Digital Therapeutics Makers Push for Medicare Coverage

As Americans head to the polls for the midterm elections tomorrow, they must consider a barrage of important issues, ranging from gas prices to abortion to climate change to public safety.

But for the digital therapeutics industry, the most important issue in the midterms may be how the outcome of the elections tomorrow will affect the fate the Access to Prescription Digital Therapeutics Act. The act would expand Medicare coverage so that it includes coverage for prescription digital therapeutics.

When she introduced the bill in March, Senate co-sponsor Shelley Moore Capito, a Republican from West Virginia, said the bill was an essential step to “harness the power of innovation in medicine.”

“Our bill ensures these prescription digital therapeutics are covered by Medicare so more patients, including seniors, have access to the cutting-edge care they deserve,” said Capito, who is not up for reelection until 2026. The House sponsor is Mike Thompson, a Northern California Democrat who is likely to be reelected.

The bipartisan support may be a good sign, but neither the House of Representatives nor the Senate has voted on it.

Andy Molnar

Andy Molnar, chief executive of the Digital Therapeutics Alliance (DTA), and Sara Elalamy, M.A., the organization’s director of government affairs, told Managed Healthcare Executive®that they and other DTA representatives have been “pounding the pavement” to advocate for the bill.

“We have been working closely with the committees of jurisdiction and remain hopeful there will be movement on the bill this year,” Molnar and Elalamy said, in an email interview.

Sara Elalamy

The legislation is seen as critical by the industry. Although a growing number of private insurers and other organizations have begun offering coverage of digital therapeutics, the lack of Medicare coverage means millions of potential customers do not have access to the digital treatments, affecting the overall market for the industry. What’s more, Medicare coverage tends to influence the coverage decisions of insurers who sell to businesses.

Molnar and Elalamy noted that digital therapeutics have advantages over other types of therapy because they can easily be administered via digital devices, even to patients who live in remote areas or areas with low access to healthcare.

“Digital therapeutics offer particular value to Medicare populations, leveraging advancements in technology to provide interventions to patients regardless of geographic location, condition severity, socioeconomic status, or the social drivers of health that contribute to disparities and inequitable care,” they said.

Digital therapeutics range in price. They don’t tend to have the high price tags of blockbuster cancer drugs or disease-modifying biologics.

Molnar and Elalamy said that as a practical matter, many patients will not be able to benefit from the kinds of evidence-backed digital therapies their members market unless Medicare covers the therapies.

“Accessibility is key to realizing the value of digital therapeutics and without Medicare coverage, only those who can pay out of pocket or lucky enough to be covered by a forward-thinking health plan will be able to benefit from these treatments, moving us further from the goal of advancing more equitable care,” they said.

Molnar and Elalamy said there has been “broad and increasing” support for the Access to Prescription Digital Therapeutics Act legislation, and said they are optimistic about its prospects in the new congress.

“We are looking forward to continuing to advocate for expanded coverage and access to digital therapeutics in the coming year and with the headway made on education efforts this year, we see a lot of momentum to build even more support in the 118th Congress,” they said in an email.