Value-Based Pilot Programs for PDTs

Diana Brixner, RPh, PhD, comments on how incorporating value-based pilot programs would impact her decision-making with PDT coverage as a payer.

Diana Brixner, RPh, PhD: Risk is an interesting issue in bringing any new therapeutic onto a health plan. [Assessing] the risk that a health plan is willing to take on can be done in steps. The unique aspect about PDTs [prescription digital therapeutics] is that you have the data to see how the patient is responding to the digital therapeutics. How often are they going on? What actions are they taking based on going onto the program? If I'm going to cover a PDT, my first question is, are my patients going to use it? That's one type of risk I'd like to minimize. If the patient is using the PDT, then yes, I'm willing to pay, but if we invested up front on the PDT because it's a one-time investment up front, and they have not gone into the system at all, I'd like to see some mitigation of that risk. For the patient's sake, is there any type of an education or intervention that we could encourage for that patient that has already made the investment to start using it and taking the benefits of the therapy?

The next level is—not as much the 1-on-1 individual patient—are they using it, and are we seeing activity that's hopefully leading to better outcomes? Lower overall economics [is] a second level of risk that's also worth exploring. [We could] have an arrangement [where our expectation up front] is that we see this much of cost savings or less resource utilization in concomitant health care that may be necessary if the PDT wasn't in place. That type of risk sharing generally involves a greater depth of access and analysis of data, but it's an important aspect of risk that should be addressed.

This transcript has been edited for clarity.

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