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Navigating Payer and Reimbursement Pathways to Scale Digital Therapeutics

I had the honor of participating in the Digimed Showcase held yesterday as part of the annual JP Morgan healthcare conference. Alongside me were veterans of the emerging digital therapeutics industry including Pierre Leurent, CEO and Founder, Voluntis and Jeff Abraham, VP, Commercial, Market Access and Trade, Akili Interactive. We were also joined by highly regarded healthcare changemakers Aaron Davis, Managing Director, Commercial Advisory Group, Syneos Health who moderated the discussion, and Susan Cantrell, representing the voice of the payer as CEO, Academy of Managed Care Pharmacy. The focus of this discussion was representative of many similar discussions that have taken place in the last few years as the venture world has turned significant attention and deal flow in our direction. That is, how do digital therapeutics get reimbursed?

While we reiterated many past points and highlighted important progress towards more uniform reimbursement mechanisms and pathways currently being scaled (See ESI and CVS Caremark digital formulary announcements, Voluntis’ progress towards a single point of service for remote patient monitoring implementation, billing, and coding, and the list goes on), I was struck by the focus on the fundamental building blocks for reimbursement that are underway. Much of the work that is being accomplished is either being led or informed by the Digital Therapeutics Alliance, led by Megan Coder; however, some of this industry building work is being independently led and prior to this discussion I have not seen a coalescence of these building blocks and their associated leaders in one resource, and thus I am hoping to contribute in one small way by organizing this progress in one chart:

I offer this up as a resource to my colleagues in the digital therapeutics space so that we know who to lean on as we build. That said, it’s important to note that this list is inherently flawed because we are all working as part of very supportive teams and within diverse ecosystems, thus the identified pioneers are likely representative of much larger groups of innovators and leaders in our space. Additionally, the documentation is largely built through the lens of product-based as opposed to service-based DTx business models. Finally, this is narrowly focused on the building blocks that are being put in to place for reimbursement and does not cover regulatory, clinical, product, and the many other vital parts of our businesses that feature their own leaders and building blocks.  

I invite my colleagues to add to this thinking, identify other resources, and fill in the missing pieces, and I thank my fellow panelists for a highly inspiring conversation.



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