Insurance Gaps Hinder Digital Therapeutics Adoption
New York, Wednesday, 5 November 2025.
Insurance coverage challenges, including uncertain reimbursement and technical barriers, impede adoption of prescription digital therapeutics, underscoring the need for systemic integration.
Understanding Digital Therapeutics
Prescription digital therapeutics (PDTs) are software-based interventions designed to prevent, manage, or treat medical conditions. Unlike general wellness apps, PDTs are FDA-regulated and require a prescription from a healthcare provider. They have shown efficacy in treating conditions such as ADHD, depression, and substance use disorders. For instance, the FDA authorized reSET for substance use disorder and reSET-O for opioid use disorder, both of which have improved patient outcomes when added to standard care [4].
Barriers to Insurance Coverage
Despite their potential, insurance coverage for PDTs remains inconsistent. The primary challenges include complex reimbursement pathways and a lack of clear evidence demonstrating long-term cost-effectiveness. Insurers are often hesitant to cover PDTs without substantial proof that they reduce costs associated with more traditional therapies, such as hospitalizations or emergency department visits. Furthermore, technical barriers such as coding issues and limited integration with electronic health records complicate reimbursement processes [1][4].
Pilot Programs and Early Adoption
Some state Medicaid programs and managed care organizations are exploring pilot programs to integrate PDTs into care management bundles. These efforts, however, represent preliminary steps rather than systematic adoption. The lack of awareness among healthcare leaders further hampers widespread acceptance of PDTs, even as artificial intelligence applications gain traction in healthcare settings [1][3].
Technical and Workflow Challenges
Healthcare providers face significant technical challenges in adopting PDTs. Inadequate coding and revenue cycle capabilities result in incorrect classification of these products, sometimes receiving behavioral health codes despite their application in other clinical areas. Additionally, limited integration with electronic health records raises concerns about data flow back to patient records, while providers worry about workflow disruptions and infrastructure inadequacies to support patients experiencing technical difficulties [1][4].
The Road Ahead for Digital Therapeutics
Addressing these challenges is crucial for the broader adoption of PDTs. Streamlining reimbursement pathways, enhancing awareness among healthcare leaders, and improving technical integration are key to leveraging digital therapeutics to improve patient outcomes. By overcoming these barriers, PDTs can become an integral part of healthcare delivery, providing innovative solutions to manage chronic conditions effectively [1][4].