Understanding Reasons Behind Payers’ Slow Uptake in Digital Therapeutics

Pharmacy Times interviewed Jayne Hornung, chief clinical officer – pharmacy, Managed Markets Insight & Technology, on her presentation at the Asembia Summit 2022 on the reasons behind payers’ slow uptake on digital therapeutics despite their clearly promising benefits.

Question: What are some potential causes of the slow uptake in digital therapeutics among payers?

Jayne Hornung: Some potential causes are that the payers are not comfortable with the amount of studies that have been done on the digital therapeutics, and although they do have to follow an FDA approval process, it's not the same process that they're comfortable with the typical pharmaceuticals that are on the market today. So until we get payers comfortable with that process, and the studies behind that process, we're going to have slow uptake in the market.

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

Jayne Hornung: So we still have patient treatment and care from our standard pharmaceuticals and cognitive therapy, where most of these digital therapies play today. So it's not interrupting the care that they receive today, but it would be a nice adjunct treatment to the care that they received today, and who knows how well patients could do on these therapies—well, we do know from some studies—in the broader population, how well people could do on these therapies, because they're just not on the market, so payers aren't paying for them.

Question: What did MMIT’s recent survey of managed care and specialty pharmacy professionals show regarding the potential causes of this slow payer uptake in digital therapeutics?

Jayne Hornung: One of the main causes of slow uptake is they don't believe that there is a lot of clinical outcomes behind the therapies. Many of the payers didn't even know a lot of the names of a lot of the therapies, so they're not familiar with them, and then when you're not familiar with something, you're likely going to not believe that it can do what it pledges it can do.

Question: What has been the impact of regulatory barriers on digital therapeutic adoption?

So there is no category or class for digital therapeutics today, when we think about Medicare and the USP model guidelines. So we need for Congress and the House to pass the act—I talked about it yesterday—that would allow for digital therapeutics to have their own categorization, and that will lead to allowing payers to put them on Medicare formularies or the medical benefit.

Question: What are some potential payer management strategies under the pharmacy benefit that could help to address these problems?

Jayne Hornung: If they could create a special class for them on the pharmacy benefit, if payers could offer a catalogue of options that they would create a payment pathway so that the employers could come to them and say, “Hey, we really want to use the app for chronic back pain for our employees that are working in a warehouse and are constantly up and down and have a lot of back problems, and we would need the pharmacy benefit to allow for coverage of these digital therapeutics through the pharmacy benefit.” They have to lay the groundwork in the structure in order for that to happen.