Understand the reasons for the slow uptake of digital therapeutics by payers

Pharmacy Times interviewed Jayne Hornung, Chief Clinical Officer – Pharmacy, Managed Markets Insight & Technology, on her presentation at Asembia Summit 2022 on the reasons behind the slow payer adoption of digital therapeutics despite their clearly promising benefits.

Question: What are some possible causes for slow payer adoption of digital therapeutics?

Jayne Horning: Some possible causes are that payers are not happy with the amount of studies that have been done on digital therapeutics, and while they have to go through an FDA approval process, it’s not the same process they accept with the typical pharmaceuticals used today are on the market. So until we familiarize payers with this process and the studies behind this process, we will have slow market adoption.

Question: How has this slow acceptance by payers impacted the delivery of patient treatment and care?

Jayne Horning: So we still have patient treatment and care with our standard pharmaceuticals and cognitive therapy, which is where most of these digital therapies play today. So it’s not interrupting the care they’re getting today, but it would be a nice add-on treatment to the care they’re getting today, and who knows how well patients with these therapies — well, we know from some studies — in the the general public how well people might do with these therapies because they just aren’t on the market, so payers aren’t paying for them.

Question: What did the recent MMIT survey of managed care and specialty pharmacy professionals find regarding the possible causes of this slow payer adoption of digital therapeutics?

Jayne Horning: One of the main reasons for the slow uptake is that they don’t believe there are many clinical outcomes behind the therapies. Many of the payers didn’t even know the names of many of the therapies, so they’re unfamiliar with them, and then if you’re unfamiliar with something, you probably won’t believe that it can do what it promises.

Question: What impact do regulatory barriers have on the adoption of digital therapies?

So there is no category or class for digital therapeutics today when we think about Medicare and the USP model guidelines. So Congress and the House of Representatives need to pass legislation — I talked about this yesterday — that would allow digital therapeutics to have their own categorization and result in payers being allowed to list them on Medicare forms or the to set medical performance.

Question: What are some potential payer management strategies within pharmacy performance that could help address these issues?

Jayne Horning: If they could create a special class for pharmacy benefit, if payers could offer a catalog of options, they would create a payment channel so employers could come up to them and say, “Hey, we really want to use the app for chronic back pain for.” our employees who work in a warehouse and are pacing and have a lot of back problems and we would need the pharmacy allowance to be able to cover these digital therapeutics through the pharmacy allowance.” You need to lay the foundations for that in the structure for that to happen can.