Opioid Addiction – Access & Reimbursement – Access & Reimbursement – Digital Therapeutics in Mental Health (US)
The rapid growth of digital therapeutic (DTx) solutions to treat medical problems, fueled by increased demand for telehealth services amid the COVID-19 pandemic, has tasked U.S. payers and pharmacy benefit managers (PBMs) with deciding if and how to cover these products that do not always fit neatly into the pharmacy or medical benefit. This report examines managed care organization (MCO) coverage and psychiatrists’ prescribing of DTx solutions for major depressive disorder (MDD), insomnia, and opioid addiction. We survey MCO pharmacy and medical directors and U.S. psychiatrists about some of the first DTx products on the market—including Pear Therapeutics’ prescription-based reSET-O for opioid addiction and Somryst for insomnia—and explore how DTx interventions will be incorporated into the treatment of the three mental health conditions.
QUESTIONS ANSWERED
- To what extent are psychiatrists aware of and using reSET-O and other digital interventions for opioid addiction, depression, and insomnia, and how do physicians rate their usability and effectiveness?
- How do MCO PDs/MDs anticipate covering DTx products in their fully insured commercial plans, including the benefit type (e.g., pharmacy, medical), and what factors will guide their decisions?
- How much of a market access advantage are FDA clearance and a prescription for a DTx in terms of MCO coverage and physician uptake?
- What barriers do psychiatrists face when prescribing / recommending a DTx, and what product features will make them more likely to use these unconventional interventions?
CONTENT HIGHLIGHTS
Geography: United States
Primary Research: Survey of 100 psychiatrists and 40 MCO pharmacy directors and medical directors.
Marketed apps covered: Deprexis, ReSET-O, Sleepio, Somryst, SparkRx
PRODUCT DESCRIPTION
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
