San Francisco, CA — Syneos Health Commercial Solutions Chief Strategy Officer Baba Shetty led a panel on the frontiers of digital therapeutics, or DTx, at the 2019 Digital Medicine & MedTech Showcase, where five eminent experts shared some progress coming out of their leading-edge field. DTx are distinct from digital health products: they’re driven by software programs and can be prescribed to prevent, manage, or treat a medical disorder or disease, as defined by the Digital Therapeutics Alliance. Panelists were closely involved and invested in the adoption of these new medications, so Shetty posed to them what may be the biggest question they’re facing: what’s the rate-limiting factor to widespread adoption of these new meds? With there being so many different stakeholders, including patients, providers and payers, panelists pointed to a number of different adoption roadblocks—and successes.
Megan Coder, Executive Director of the Digital Therapeutics Alliance, outlined some communication issues on both the developer side and the patient/provider side. “This isn’t health-and-wellness for the sake of health-and-wellness. Those products may be fantastic but they serve a very different purpose. These are a unique subset of products that can change things,” she said. “The rate limiting factor is just understanding what these tools are, what value they bring, how they can be integrated, what they do, and how they differ from other products.”
Highlighting some larger obstacles, Susan Cantrell, CEO of the Academy of Managed Care Pharmacy, pointed to the payment structures within American healthcare and how ripe they are for change. “As we all know, payment is siloed into medical benefit and pharmacy benefit and not much in between. On the medical side they say, ‘This isn’t medical benefit,’ and on the pharmacy side they say, ‘This isn’t really a drug. How do we pay for it?’” Cantrell pointed out that other novel treatments are working to surmount similar hurdles. “Much like our emerging therapies, like gene editing tools, it’s a new platform, and…we’re treating very complex conditions for which our current solutions fall short. So, we just have to come up with new systems and processes to accommodate the change.”
In a similar vein, Yuri Maricich, Chief Medical Officer of Pear Therapeutics, put the matter in historical perspective. “When complex biologics came out, that was a big deal. It took long time to figure out—for clinicians to feel comfortable with that administration and prescribe the drugs. Now they’re commonplace,” he said. So, how long until DTx are commonplace? “I really do believe we’re at that tipping point. It’s no longer, ‘Why should I prescribe this app?’ but ‘How do I prescribe this, how do I implement this in my clinical practice, and how do I get payers to pay for it?’ We’re seeing early interest. We’ve had payers reach out to us.”
In fact, DTx are already helping many patients, Maricich said, making the comparison, like Cantrell, to gene therapy. “How many of us know a patient treated with gene therapy? But they’re out there, and the therapies are going to cure many diseases.”
The groundbreaking development of DTx comes along with numerous challenges, some of which cast new light on the greatest challenges in healthcare generally. With DTx being hard for payers and providers to taxonomize medically, new systems of reimbursement and payment may be more necessary than ever before. Though there’s a long way to go, we are already seeing some small-scale instances of a landscape in transition. For example, in England, the NHS is working with NICE to support a new digitally enabled therapy-assessment program. And in Germany, sickness funds are providing beneficiaries with access to, and reimbursement for, certain DTx products. In the U.S. too, some payer-provider networks are making early efforts to enable DTx access.
Reimbursement presents the biggest obstacle when it comes to DTx adoption. But there’s also a more abstract roadblock: stakeholders of all kinds, along with the general public, tend to have fairly fixed definitions of “medication,” definitions that aren’t right away ready to make room for video games. But DTx’s great promise—the number of disease states whose outcomes they can vastly improve—demands careful action, open-mindedness, and perhaps an experimental spirit from all healthcare stakeholders committed to staying relevant.
Read more of our perspectives about digital therapeutics: what they look like and what’s needed to make them available to the public by clicking here. You can read an executive summary of our upcoming report here.