More than 78 million Americans rely on Medicaid or CHIP for their medical care. However, many of these individuals cannot access FDA-approved digital therapeutics because their state Medicaid programs do not cover these therapies. Prescription digital therapeutics (PDTs) are FDA-sanctioned software-based treatments for managing conditions like substance use disorder, ADHD, diabetes, and chronic insomnia. Administered through smartphones or tablets, PDTs present a groundbreaking method of healthcare, particularly for those enduring long waits or who lack access to face-to-face treatment.
Pharmacists are especially positioned to aid in broadening access to PDTs. Within managed care environments, they engage in formulary assessments and policy dialogues, while in community contexts, they inform patients, support treatment compliance, and incorporate these resources into medication therapy management. Their knowledge and presence make them critical participants in healthcare provision and policy development. In various states, pharmacists serve on Medicaid advisory panels or provide feedback during benefit evaluation exercises.
Preliminary outcomes from a pilot program in Pennsylvania suggest that patients with opioid use disorder who routinely utilized a digital therapeutic showed a decrease in relapses and emergency room visits. Though comprehensive information is still forthcoming, these findings resonate with other studies emphasizing the effectiveness of PDTs in long-term management and diminishing hospital utilization.
The German healthcare system presents a successful framework through its DiGA initiative, which finances prescription digital therapeutics. Since its launch, more than 860,000 prescriptions have been issued, totaling around €234 million, a small fraction (less than 0.05%) of the country’s annual healthcare spending. While the U.S. healthcare system is distinct, the experience from Germany indicates that incorporating digital therapeutics into a national health scheme is practical and financially viable.
In the U.S., additional research is crucial to assess the influence of PDTs on Medicaid expenses and patient results. Nevertheless, experts maintain that these resources could lower preventable hospital admissions by improving treatment compliance and follow-up care. The potential for PDTs to benefit Medicaid patients, particularly in underserved regions, is substantial.
Pharmacists serve as key access points for digital health solutions; over 90% of Americans reside within five miles of a pharmacy. Nonetheless, internet access poses a challenge—roughly 25% of Medicaid beneficiaries either do not have home broadband or depend solely on smartphones. With the impending end of the Affordable Connectivity Program in 2024, pharmacists can fill this void by linking patients to local resources and aiding in the utilization of digital tools at the point of care.
The anticipated introduction of the Access to Prescription Digital Therapeutics Act (HR 3288 and S 1702) in 2025 could enable Medicare and Medicaid to cover PDTs and create billing codes. Pharmacy organizations have supported this legislation. If enacted, state Medicaid programs will primarily dictate coverage specifics, highlighting the need for local pharmacist engagement in these choices.
Already skilled in managing chronic conditions, mental health issues, and patient education, pharmacists possess the necessary expertise to integrate digital therapeutics into everyday healthcare. Their frequent interactions with patients place them in an ideal position to boost access to these therapies and enhance overall patient care.
Access to treatment must not depend on private insurance coverage. By shaping policy, educating patients, and collaborating with Medicaid programs, pharmacists can ensure that digital therapeutics are available to those who need them. These innovations are part of healthcare systems in other nations and should be adopted into Medicaid provisions in the U.S. as well.