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: Sen. Capito, Shelley Moore [R-WV]
Target Audience
Population: Individuals who are eligible for Medicare, Medicaid, and similar healthcare programs globally
Estimated Size: 100000000
- Prescription digital therapeutics are software applications used to prevent, manage, or treat medical conditions.
- The bill provides provision for Medicare and Medicaid coverage of such therapeutics, directly affecting those enrolled in these programs.
- In the U.S., a significant number of individuals are enrolled in Medicare (approximately 63 million) and Medicaid (approximately 83 million as of 2021).
- Globally, the adoption of digital therapeutics is on the rise, with many countries and private sectors exploring or implementing similar healthcare technologies.
Reasoning
- The policy is targeted at enhancing access to prescription digital therapeutics through Medicare and Medicaid, potentially impacting beneficiaries who have access to these programs.
- Given the budget constraints, the policy would prioritize individuals with chronic or complex conditions who can benefit the most from digital therapeutics.
- Not all Medicare/Medicaid enrollees will immediately adopt or benefit from this policy, but a targeted group experiencing chronic conditions will.
- The diversity within the population includes differing socioeconomic statuses, health needs, and access levels to technology, which will reflect on the impact estimates.
Simulated Interviews
retired (Florida)
Age: 67 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- I worry about managing my diabetes daily, and anything that can help would be great.
- Prescription digital therapeutics sound useful, but I'm unsure how to access them or if my doctors will recommend them.
- Medicare covering these costs is a relief; I hope they personalize these tools to my condition.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
IT specialist (New York)
Age: 45 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Mental health apps are helpful in tracking moods and providing exercises in real-time.
- Accessibility through Medicaid could mean a significant change for my therapy adherence.
- I'm concerned about data privacy with more use of digital tools.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 6 |
retired nurse (California)
Age: 80 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- I still have trouble with basic tasks post-stroke, and am worried about rehabilitation.
- Digital rehabilitation tools could aid in my recovery, but I'm not tech-savvy.
- It's vital that these tools are easy to use for older generations.
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 | 6 | 2 |
| Year 20 | 6 | 2 |
unemployed (Texas)
Age: 55 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 9/20
Statement of Opinion:
- Managing both diabetes and hypertension is costly and challenging.
- If digital tools can help track my health data and med intake, that's a big plus.
- Skeptical about effectiveness, want to see results before committing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
part-time retail worker (Illinois)
Age: 30 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 12/20
Statement of Opinion:
- Digital therapeutics might reduce my need for in-person therapy visits.
- These apps could complement my current therapy routine.
- It's important they are engaging, otherwise I'm unlikely to use them regularly.
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 | 7 |
| Year 20 | 8 | 7 |
retired engineer (Oregon)
Age: 72 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 4.0 years
Commonness: 7/20
Statement of Opinion:
- Helping manage my heart condition is crucial, I often forget medications.
- If digital tools improve medication reminders and tracking, that’s beneficial.
- I worry about being able to use such technology effectively without help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
student (Alabama)
Age: 22 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 8.0 years
Commonness: 14/20
Statement of Opinion:
- Managing asthma is stressful, especially during pollen season.
- Digital therapeutics for monitoring air quality and symptoms would be amazing.
- I hope the coverage extends to apps tailored for young adults.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 9 | 8 |
| Year 10 | 9 | 9 |
| Year 20 | 9 | 9 |
factory worker (Ohio)
Age: 50 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- Digital therapeutics might offer pain management solutions lessening reliance on meds.
- Integration of these tools with existing healthcare services is key for veterans.
- Initial cost is a concern, but long-term savings if it helps manage pain.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
chef (Washington)
Age: 36 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 15.0 years
Commonness: 11/20
Statement of Opinion:
- Digital coach and health tracking could be a positive step towards weight management.
- Cultural recipes included in apps could motivate me more to use them regularly.
- Would appreciate dietary suggestions directly linked to my health data.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
unemployed (Missouri)
Age: 60 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 8/20
Statement of Opinion:
- COPD is a daily challenge, any technology that aids in monitoring would be valuable.
- As I age, I hope these therapeutics are easy to adapt to.
- My concern lies with additional costs not covered by Medicare.
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 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Cost Estimates
Year 1: $750000000 (Low: $500000000, High: $1000000000)
Year 2: $800000000 (Low: $550000000, High: $1050000000)
Year 3: $850000000 (Low: $600000000, High: $1100000000)
Year 5: $950000000 (Low: $650000000, High: $1150000000)
Year 10: $1100000000 (Low: $700000000, High: $1300000000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- The success and efficiency of digital therapeutics depend on reliable software delivery and updates.
- Adoption and adherence rates among elderly and low-income populations must be addressed.
- Regulatory developments and compliance could influence future cost structures.