Digital therapeutics formularies five years away in US, say payers

Payers from the US may not include digital therapeutics products on formularies for another five years, according to a report.

Healthcare services firm Icon conducted in-depth interviews with 10 pharmacy and medical directors from health plans and pharmacy benefit managers in the US, to gauge their thoughts on reimbursing digital therapeutics (DTx).

DTx are digital interventions that have been shown to provide health benefits in the clinic, and a number are already on the market for a range of conditions including diabetes and mental health.

While most organisations were prepared to evaluate cost-effectiveness of DTx products, it was a different story when they were asked whether they could be included in formularies.

Icon asked respondents whether they would be interested in setting up special formularies, and the response was lukewarm.

They said the infrastructure to set up a digital health formulary would take 12-18 months to set up but there is “little impetus” to start this.

A move in this direction would be three to five years down the road.

On the plus side they noted that a formulary would work well in situations where there are several DTx options, such as in diabetes.

The plan could then choose a preferred option based on evidence or manufacturers’ rebates or discounts.

But this process would require more evidence from manufacturers to differentiate between offerings, something which is lacking at the moment, according to the interviewees.

Respondents voiced reservations about adopting a formulary approach because the technology is so new and because of the lack of evidence for product comparisons.

There was also a concern that DTx coverage could increase the cost to plan members, although a way around this would be to create a separate digital health formulary and allow plan members to opt in or opt out.

“Digital therapeutics studies are not being designed with an active comparator arm or against other digital therapeutics, so it is based on indirect comparisons,” said one pharmacy director for a regional health plan interviewed by Icon.

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