Manufacturer, Payer Collaboration Is Needed for PDT Coverage, Says Kelly Price

To try to get a prescription digital therapeutic (PDT) covered, manufacturers need to align the value of their product to the priority of the payer, said Kelly Price, US head of rare disease at HRA Pharma.

Transcript

What goes into a payer’s decision whether to cover a PDT?

I'm asking myself that all the time. I think this is where—and I say this a lot—when you've seen 1 PDT, you've seen 1 PDT. We used to say that about payers a lot on the manufacturer side, where when you've talked to 1 payer, you've talked to 1 payer. I think payers have different priorities right now and you really have to align your value as a product to what is the priority of the payer, and can there be synergy, and [are] there shared outcomes and objectives that you can achieve together. But I think it's a little bit different with payers right now in that it really is going to require collaboration. This isn't going to be a contract of a one and done; there's a lot for us all to learn.

I encourage payers—I want to be a partner, I don't have all the answers, I want to be transparent about what the product can do or can't do, but I also want the payer to be really transparent. What are they concerned about? What are their fears around PDTs? And we always assume that it's cost. Sometimes it's not cost, sometimes it's about "I don't know how to raise this to a higher level in the organization, I'm not sure who is responsible for making these decisions," so it's really just about really talking with each other. What are our priorities? How do we match those priorities? And then how do we collaborate? Because this is a new space that there's a lot to learn.

I always say I'm shooting for progress in a conversation, not perfection. We're not going to end up with a contract that's perfect, going to benefit everybody in every way. So it's really about finding those common goals, common objectives, how we can work together, and then collaborate and really share information openly and in earnest.