New Guidelines Launched for Coverage of Digital Therapeutics by Health Plans
Arlington, Saturday, 12 July 2025.
The AMCP has set forth principles to assist health plans in managing the coverage and reimbursement of Prescription Digital Therapeutics. These guidelines aim to streamline decision-making and ensure effective patient care.
Introduction to Digital Therapeutics
Prescription Digital Therapeutics (PDTs) are software-based interventions that deliver therapeutic benefits directly to patients via smartphones or tablets. These tools are designed to address a range of conditions, including substance use disorder, ADHD, diabetes, and chronic insomnia, by offering interventions that are often used in conjunction with traditional medications [3].
The Need for New Guidelines
As the digital health landscape rapidly evolves, the Academy of Managed Care Pharmacy (AMCP) has published principles to guide health plans in evaluating the coverage and reimbursement of PDTs [1]. These guidelines are timely, given that more than 78 million Americans rely on Medicaid or CHIP for healthcare, yet many encounter limitations to accessing FDA-approved digital therapeutics due to state coverage restrictions [3].
Framework for Evaluating Digital Therapeutics
The guidelines established by the AMCP seek to provide digital health innovators with clear definitions and principles for assessing the safety and efficacy of PDTs. This initiative promises to standardize decision-making processes, ensuring that healthcare payers can more efficiently integrate PDTs into their coverage plans [1][2].
Impact on Patient Care and Coverage
Effective implementation of these principles can significantly enhance patient care by expanding access to PDTs, particularly for Medicaid enrollees who often face barriers due to limitations in broadband access [2][3]. Efforts to improve the integration of digital therapeutics into Medicaid could lower preventable hospital visits by improving the follow-up and adherence of patients using these therapies [3].
Looking Forward
The development of these guidelines marks a significant step towards funding digital health solutions that are both effective and financially sustainable. The AMCP plans to finalize these guidelines by the end of 2025 [2]. Such efforts highlight the crucial role of pharmacists in advocating for and facilitating access to digital therapeutics within public health frameworks [3].