Improving the Payer-Provider Relationship Influencing PDT Use

Two medical experts relay their ideas on how to better improve the payer-provider relationship surrounding PDT use.

Diana Brixner, RPh, PhD: The coordination between providers and payers is important. If you think about it in 2 separate worlds, a provider has a patient, and for whatever reason, they believe that a PDT [prescription digital therapeutic] would help them. There's a significant unmet need. There's a gap and the PDT could potentially address that gap and help their patient. If they want the access to the PDT for their patient, they have to be aware of what the health coverage their patient has is and whether that particular coverage incorporates access to a PDT. If there is access, then it should be as simple as an e-prescription to a pharmacy. The patient goes and picks up the prescription, loads it on their phone, and they're good to go. However, as we talked about earlier, if it's not covered, then what is the process [of obtaining] authorization to have their patient have access to that product? There's an important coordination between knowledge of the provider as to what the access and availability is from the insurer of the patient. [We also need] education by the payer, so that the providers that are part of the network for that payer are aware of what the access capabilities are to PDTs.

Arwen Podesta, MD: Providers don't know how much [access payers have] to data because when I see a patient, and they miss my next appointment and end up in a hospital somewhere else in another county, I won't know that. Payers have a window into the chronicity and continuity of treatment regimens for patients. Payers have an opportunity to make recommendations for things that might not have been recommended yet, including PDTs. Prescribers have a difficult time being told by payers what to prescribe, but if there's something that we don't know about that might be beneficial to fill the gaps, then it's a great area for payers to say, “This could be an addendum or an addition or a synergistic piece to the patient's treatment. Let's think about prescribing it.” There is a great avenue for payers and prescribers to work together, and I'm pleased to be in a boat where I'm able to do that.

This transcript has been edited for clarity.

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