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When Will Payers Improve Coverage of Prescription Digital Therapeutics?

August

03

2022

At age 19, my stepson has run the gamut of therapeutic options—combination therapies, cognitive behavioral therapy, you name it—for treating his attention deficit hyperactivity disorder (ADHD). After 10 years of searching, we have yet to find a treatment that truly works for him.

However, there’s one option that we haven’t tried: prescription digital therapeutics (PDTs). More specifically, an app-based video game called EndeavorRx. The game, which was approved by FDA in June 2020, is a first-of-its-kind treatment that uses stimuli and motor conditioning to target areas of the brain that control attention function. And the results are impressive: 68% of parents reported improvement in ADHD-related impairments after two months of treatment.

This app could be a game-changer for my stepson and thousands of children just like him. However, despite clearly demonstrated clinical efficacy and very few reported side effects, he can’t use EndeavorRx to treat his ADHD. Why? Because our health insurance doesn’t cover it.

The Missed Opportunity

PDTs are designed and tested much like traditional prescription drugs, but rather than swallowing a pill or taking an injection, patients receive cognitive therapy through software. In addition to ADHD, there are FDA-approved PDTs available for treating substance use disorder, irritable bowel syndrome, PTSD, insomnia, autism, and more.

Yet despite the many FDA-approved options on the market, widespread coverage is sorely lacking: Today, less than half of payers (25%) say that they are willing to cover PDTs, according to MMIT’s recent survey of 16 payers. What’s more, 76% of respondents rated PDTs as a low to moderate priority.

Read more in the PharmExec article.

Jayne Hornung

Jayne Hornung

Jayne Hornung, MMIT’s Chief Clinical Officer, has led the company’s clinical team for the past five years. Jayne maintains a sharp focus on the evolving market access landscape, especially in oncology and complex disease states. In an almost two-decade career with MMIT, Jayne’s research into drug, indication and policy data has helped hundreds of pharmaceutical clients understand market access from a clinical perspective. Prior to joining the company, Jayne worked in various positions across the healthcare and pharma industries, and once owned and operated an independent pharmacy. She graduated as a clinical pharmacist from Philadelphia College of Pharmacy in the late 1990s.

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