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Thought Leadership

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When Will Payers Improve Coverage of Prescription Digital Therapeutics?

By Jayne Hornung

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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Jayne Hornung

Jayne Hornung

Jayne Hornung is the Chief Clinical Officer at MMIT (Managed Markets Insight & Technology), a trusted go-to-market partner who believes that patients who need lifesaving therapies shouldn't face delays because accessing drugs can be confusing. She is a clinical pharmacist and has been one of MMIT’s clinical subject matter experts for the past 13 years. In her role, she conducts research of drug, indication and policy data and helps MMIT’s clients understand market access from a clinical perspective. You can find her on LinkedIn.

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