Health care decision-makers are reviewing digital therapeutics with an emphasis on mobile apps, but prior authorization coverage is being provided to a limited number, reported study authors at AMCP Nexus 2022.

To gather insights on digital therapeutics product evaluations, evidence exchange approaches, and formulary coverage and utilization management, researchers conducted a double-blind web-based survey between April 2022 and May 2022, which was completed by 50 respondents.

Per the results, mobile apps (60%) were the most often reviewed digital therapeutics followed by drug-delivery device combinations (44%), and medication adherence platforms (38%) in the past 12 to 18 months.

Researchers reported that coverage benefit was most commonly dependent on the specific product (42%), but mobile apps (30%) and drug delivery device combinations (25%) were depicted as having preferred coverage status with prior authorization (47%, 73% respectively).

“Most (64%) reported that they definitely would cover or would be more likely to cover prescription-only digital therapeutics, but proof of long-term benefit (84%), patient adherence (72%), and fulfillment (54%) remain as barriers,” wrote investigators.

The primary driver (72%) among respondents who do not cover digital therapeutics was a lack of evidence of long-term clinical efficacy.

Findings showed 34% of respondents reported that the establishment of the Healthcare Common Procedural Coding System (HCPCS) code would increase coverage of digital therapeutics on the medical benefit and 38% noted it would have no impact on coverage at all.

Furthermore, respondents would prefer an Academy of Managed Care Pharmacy (AMCP) format dossier (29%), manufacturer representative (29%), or the FormularyDecisions platform (25%) when receiving information on digital therapeutics products.

“Coverage appears to be more likely for prescription-only digital therapeutics; however, challenges with proof of long-term benefit, patient adherence, and fulfillment remain,” concluded authors. “While benefit type is primarily product-specific, the establishment of the HCPCS code may lead to greater digital therapeutics coverage under the medical benefit.”

Reference:
Bannister B, Sauvageau G, Carpenter B, Kilgore A, Regan T, Hughes J. Payer perceptions and formulary coverage trends for digital therapeutics. J Manag Care Spec Pharm. 2022;28(10-a suppl):S1-S137. doi:10.18553/jmcp.2022.28.10-a.s1