US bill pushes Medicare and Medicaid categories for prescription digital therapeutics

pharmafile | March 14, 2023 | News story | Medical Communications  

Both the US House of Representatives and Senate are considering a bill which would encourage the adoption of prescription digital therapies (DTx) by making dedicated benefit categories for eligible products in Medicare and Medicaid.


The bill, named the Access to Prescription Digital Therapeutics Act, defines a prescription DTx as “a product that uses software to achieve its intended result, is cleared or approved by the […] FDA for the prevention, management or treatment of a medical condition, and is authorised by a qualified, licensed clinician.” It is intended to allow Medicare and Medicaid to cover and create product-specific codes for DTx, which would set up a payment system that could vastly improve the availability of US prescriptions for DTx supporters have said.


The bill was first introduced in March 2022, with this renewed version offering more evidence that DTx can complement other therapies for a wide range of health conditions. It puts forward that the bill could lead to reduced costs and improved patient engagement. However, DTx is still relatively new, and the bill could be held back by the global lack of clinical, regulatory and reimbursement standards.


Senator Jeanne Shaheen stated: “Prescription digital therapeutics are tested and regulated like traditional prescription medication, so it’s common sense that we remove barriers to care for those who respond positively to this kind of treatment.”


Senator Shelly Moore Capito commented that the bill “allow[s] more patients living with a broad variety of diseases and conditions – from substance and opioid use disorders, and mental and behavioural health issues, to diabetes and Parkinson’s disease – to more efficiently access the care and support they need and deserve.”


James Spargo

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