Managed Care Considerations for Prescription Digital Therapeutics

Several studies suggest prescription digital therapeutics offer promising cost-effectiveness benefits, though real-world evidence remains somewhat limited. Patients can receive care through smartphones without traveling to medical offices, reducing time and resource consumption while enabling providers to extend their reach directly into patients' homes. The economic value becomes particularly evident when considering reduced inpatient visits and shortened wait times—some specialty services have 3-year waiting lists, and prescription digital therapeutics (PDTs) could dramatically reduce diagnostic and treatment delays within behavioral health ecosystems, benefiting patients, providers, and health plans.

The current political environment creates unique opportunities for PDT integration within managed care organizations, particularly as recent legislation impacts Medicaid reimbursements. PDTs serve as valuable tools for reducing overall care costs through cognitive behavioral therapy delivery while decreasing hospital admissions and emergency department visits. These digital therapeutics align well with quality metrics that state Medicaid agencies must report to CMS, including hospital readmissions and emergency department visits, making them attractive options for managed care organizations operating under Section 1115 waivers that must increasingly align with federal quality priorities.

The biggest unmet need for wider PDT adoption across mental health conditions is comprehensive education for health care providers about these technologies' value and implementation. Providers need clear answers about workflow impacts and support for integrating PDTs into their practices. Pharmaceutical manufacturers must help facilitate this transition by addressing provider concerns and supporting workflow adaptation. Success requires focused efforts on educating both providers and payers about PDT benefits while developing robust support systems that address technical challenges and ensure seamless integration into existing health care delivery models.