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Senators Introduce Bill to Support Coverage of Digital Therapeutics

Analysis  |  By Eric Wicklund  
   December 15, 2022

The Medicaid and CHIP Access to Prescription Digital Therapeutics Act, introduced this week in Congress, would create standardized coverage in Medicaid and CHIP plans for approved digital health tools and platforms.

A new bill introduced to Congress aims to improve coverage for digital therapeutics in Medicaid and state Children's Health Insurance Programs (CHIPs).

The Medicaid and CHIP Access to Prescription Digital Therapeutics Act (S.5238), introduced on December 12 by Senators Shelley Moore Capito (R-WV) and Jeanne Shaheen (D-NH), would make it easier for clinicians to prescribe innovative new technologies, such as digital health devices and mHealth apps.

“Digital therapeutics hold particular value for Medicaid populations with convenient, accessible, and personalized treatment options to address many unmet medical needs,” Andy Molnar, chief executive officer of the Digital Therapeutics Alliance (DTA), said in a press release announcing the DTA's support for the bill. “This legislation would establish more clarity and uniformity in how prescription digital therapeutics are covered by public programs from state to state and is a critical step toward ensuring that these evidence-based treatments get into the hands of those who need them most.”

While the text of the bill wasn't yet available, supporters said it would, if passed, define 'prescription digital therapeutic' for Medicaid coverage, create standardized coverage for digital therapeutics treatments approved or cleared by the US Food and Drug Administration (FDA) in Medicaid and CHIP programs and give the Health and Human Services Secretary the ability to provide technical assistance to states considering such coverage.

The bill represents a growing interest in the use of digital health tools and platforms to treat chronic conditions and other health concerns, giving healthcare providers new options that don’t necessarily include drugs or in-patient treatments.

It also tackles one of the biggest barriers to adoption: payer coverage. Unless payers support these new treatments, providers have little incentive to prescribe them. Some health plans and private insurers have shown support for digital therapeutics, but the industry needs the backing of Medicare and Medicaid plans, who cover many of the populations that would greatly benefit from their use.

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.

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