Chronic Kidney Disease is when the kidneys gradually get damaged over time and the kidneys are unable to complete functions such as removing wastes from your body, maintain blood pressure, and keeping your bones healthy.
Operational Readiness Covering Prescription Digital Therapeutics
The Academy of Managed Care Pharmacy (AMCP) convened a focus group in March 2024 to discuss operationalizing the coverage of prescription digital therapeutics (PDTs) by health payers. The focus group was comprised of seven health payer experts from commercial health plans, pharmacy benefit managers, and state Medicaid programs. The focus group discussed the following issues:
- Evidentiary standards that justify coverage.
- Coding practices required to facilitate coverage.
- Considerations for benefit design.
- Unique supply chain and reimbursement requirements.
- Federal legislation that would authorize Medicare coverage of PDTs.
PDTs offer significant promise in treating certain conditions and improving access to care, but participants agreed that a new modality requires new approaches to coverage. This brief, which summarizes the focus group’s findings, is intended to help prepare the American health care system to begin covering PDTs.
- Health payer readers will learn about the unique considerations for evaluating PDTs for coverage and incorporating them into their benefit design.
- PDT developer readers will learn more about the needs of health payers to better inform the development of their products and informational materials.
Learn more about our advocacy on Digital Therapeutics and the Access to Prescription Digital Therapeutics Act of 2023 (S.723/H.R. 1458), an important bipartisan bill that will improve care for millions of Americans by expanding coverage of prescription digital therapeutics (PDTs).
Related
Prescription Digital Therapeutics (PDTs) offer vast opportunities but require careful consideration for coverage and reimbursement. At the direction of the AMCP Board of Directors we have developed definitions and principles to simplify your decision-making and provide digital health innovators with essential insights for evaluating safety and efficacy.
The United States Pharmacopeia Convention (USP) and the United States Food and Drug Administration (FDA) have updated an educational resource on biosimilars to help healthcare practitioners improve patient confidence in the quality and effectiveness of these treatment options. The following are recommended social media, website, and email content you can use to share this resource with your network.
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