Bill Overview
Title: Access to Prescription Digital Therapeutics Act of 2022
Description: This bill provides for Medicare and Medicaid coverage of prescription digital therapeutics (i.e., software applications that are used to prevent, manage, or treat medical conditions). The Centers for Medicare & Medicaid Services must establish a Medicare payment methodology for payments to manufacturers that takes into account certain factors (e.g., ongoing use); manufacturers must report specified information about private payors, subject to civil penalties.
Sponsors: Rep. Thompson, Mike [D-CA-5]
Target Audience
Population: People on Medicare or Medicaid with conditions treatable by digital therapeutics
Estimated Size: 110000000
- The bill aims to provide Medicare and Medicaid coverage for prescription digital therapeutics.
- Prescription digital therapeutics are software applications that can treat, manage, or prevent medical conditions.
- Medicare primarily serves individuals who are 65 years and older, as well as younger people with disabilities.
- Medicaid provides health coverage to low-income individuals, including families and children, pregnant women, the elderly, and people with disabilities.
- The use of digital therapeutics is becoming more widespread as technology advances and integrates with healthcare services.
- The people impacted will predominantly include those who are already engaged with the healthcare system through Medicare or Medicaid and have a condition that can be managed or treated with digital therapeutics.
- This could also potentially impact healthcare providers involved in managing the health of these individuals.
Reasoning
- The target population mainly includes individuals enrolled in Medicare or Medicaid who can benefit from digital therapeutics.
- The legislation is beneficial primarily for those who have conditions manageable with digital therapeutics.
- The projected budget suggests limited immediate impact, but potential for broader benefits over time.
- A person's wellbeing might be affected by changes in access to healthcare solutions, which can manage or alleviate symptoms effectively.
Simulated Interviews
Retired teacher (Rural Georgia)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 12/20
Statement of Opinion:
- Digital therapeutics could be a game-changer for managing my condition from home.
- Access could reduce my travel for medical checkups.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Software developer (Seattle, Washington)
Age: 47 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 9/20
Statement of Opinion:
- Digital therapeutics may help manage my mental health more effectively.
- This would complement ongoing therapy sessions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
Caregiver (Phoenix, Arizona)
Age: 55 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I hope digital tools will help keep my blood pressure under control more effectively.
- Less hospital visits would also help financially.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Freelancer (New York City, New York)
Age: 30 | Gender: other
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Digital therapeutics can offer 24/7 support for my anxiety management.
- Potentially bridging gaps in my current treatment.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 7 | 3 |
Retired engineer (Texas)
Age: 82 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Access to digital health solutions could simplify monitoring my condition.
- It might save many trips to specialists.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 4 |
Grandmother (Florida)
Age: 67 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- Having access to respiratory management software could improve daily living.
- I am curious if it will work as advertised.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Student (Chicago, Illinois)
Age: 26 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 11/20
Statement of Opinion:
- I wonder if digital therapeutics could help me manage my asthma more proactively.
- Cost savings from reduced flare-ups would be a boon.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Nurse (North Carolina)
Age: 62 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 12/20
Statement of Opinion:
- Digital applications might provide novel ways to manage my pain effectively.
- It could lessen my dependency on physical therapy sessions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Retired (Oregon)
Age: 79 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 7.0 years
Commonness: 9/20
Statement of Opinion:
- I am skeptical but hopeful that digital tools will aid in managing my symptoms.
- It would be nice to try new ways to track my health.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 6 | 3 |
Part-time librarian (Ohio)
Age: 58 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Digital therapeutics can offer more control over my health from home.
- I'm excited to see how these tools work for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $1500000000 (Low: $1200000000, High: $1800000000)
Year 2: $1300000000 (Low: $1100000000, High: $1600000000)
Year 3: $1200000000 (Low: $1000000000, High: $1500000000)
Year 5: $1100000000 (Low: $900000000, High: $1400000000)
Year 10: $1000000000 (Low: $800000000, High: $1200000000)
Year 100: $800000000 (Low: $600000000, High: $1000000000)
Key Considerations
- The bill requires manufacturers to report private payor information, which could influence the pricing and availability of digital therapeutics.
- Interoperability concerns between new digital therapeutic platforms and existing healthcare data systems must be managed.
- The potential for improved patient health outcomes might reduce long-term healthcare spending.