When Will Payers Improve Coverage of Prescription Digital Therapeutics?
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.
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