“A long way to go” for digital health reimbursement

A recent analysis delves into the challenges companies face in getting digital health technologies reimbursed and presents recommendations for how these products can find a smoother path to market.

This article appears in our free digital magazine Deep Dive: Market Access 2021. Read a preview below:

In many ways, the healthcare sector is still wrestling with how best to regulate and reimburse digital health technologies (DHTs) – which include artificial intelligence, cloud-based services and digital devices – and as a result uptake of these technologies has been slow with patients and payers alike, despite clear interest in their utility.

Most existing value assessment methodologies are designed for pharmaceutical products and are not well-suited to DHTs. Compounding this problem is the fact that the healthcare sector is often glacial in its pace of change, while digital innovations are evolving rapidly every year. Nevertheless, with many DHTs showing great promise in helping patients and creating value for payers, a more pragmatic approach to reimbursement is needed soon.

Progress is being made in several markets, and Dr Lorenzo D’Angelo, principal in CRA’s Life Sciences Practice, notes that COVID-19 could act as a catalyst for national and local reimbursement systems to start tackling this issue.

“While there are still roadblocks, the pandemic has opened up opportunities and accelerated the acceptance of this technology – and with that acceptance comes pressure on payers to see more of these technologies funded,” he says.

But uncertainty remains over optimal trial designs for gathering evidence, the kinds of value payers actually want to see, and the reimbursement and coverage options available. The FDA, for example, has gone back and forth on whether to keep a truncated digital health pathway implemented during COVID-19 in place after the pandemic.

In a recent report, ‘Challenges and solutions to bringing digital health technologies to market’, analysts from CRA take a look at the major access and regulatory barriers facing companies attempting to launch DHTs, and ask how the industry can overcome these challenges and work with payers to make access pathways easier to navigate.

The authors note that there is a “long way to go” to achieve this – but there is a strong public health need for standardisation to encourage the development and appropriate utilisation of digital health innovations.

And within this environment, the pharma and digital health industries have an opportunity to show leadership in helping reimbursement for DHTs find its footing.

• Read the full article in pharmaphorum's Deep Dive digital magazine