Bill Overview
Title: Medicaid and CHIP Access to Prescription Digital Therapeutics Act
Description: This bill requires the Centers for Medicare & Medicaid Services to issue guidance for states on coverage of prescription digital therapeutics (i.e., software applications that are used to prevent, manage, or treat medical conditions) under Medicaid and the Children's Health Insurance Program (CHIP).
Sponsors: Sen. Capito, Shelley Moore [R-WV]
Target Audience
Population: People eligible for Medicaid and CHIP worldwide
Estimated Size: 83000000
- Medicaid and CHIP are healthcare programs in the United States that provide coverage to low-income individuals and families.
- Medicaid serves low-income adults, children, pregnant women, elderly adults, and people with disabilities.
- CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to afford private coverage.
- The target population for this legislation includes individuals eligible for Medicaid and CHIP who can utilize prescription digital therapeutics.
- Digital therapeutics can be used to manage or treat medical conditions, which could affect a broad range of medical issues experienced by Medicaid and CHIP beneficiaries.
Reasoning
- The Medicaid and CHIP Access to Prescription Digital Therapeutics Act targets a diverse population that is part of the Medicaid and CHIP programs. This population includes low-income families, children, and people with disabilities among others.
- Prescription digital therapeutics aim to manage or treat medical conditions through software applications, which can significantly impact well-being by providing timely and potentially more affordable healthcare solutions.
- The budget and scope of $500,000,000 USD in year one is ample to initiate coverage, given the target audience size within the limit of available funds.
- We will include people in varying situations regarding occupation, health, and access to digital technology to represent a diverse array of possible impacts.
- Some people within the eligible group might not see a significant change in their self-reported well-being due to individual health conditions or other personal factors.
- It is also plausible that the utilization of digital therapeutics could lead to improvements in managing chronic conditions, mental health, and other long-term health challenges.
Simulated Interviews
Unemployed (Rural Texas)
Age: 45 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- I'm hopeful that digital therapeutics could help manage my condition better since traveling to a doctor is challenging due to distance.
- If digital therapeutics work for me, it might ease some of my pain and improve my quality of life.
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 | 7 | 3 |
Retail Worker (Chicago, IL)
Age: 27 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 8/20
Statement of Opinion:
- I'm not sure how much impact the policy will have on my family right now since we're mostly healthy.
- It sounds great for people with specific health needs, but I hope it doesn't increase costs for our current coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Part-time librarian (New York, NY)
Age: 60 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- I'm quite interested in managing my diabetes better with digital therapeutics as they seem convenient.
- If this can help keep my insulin costs down and my health stable, it's a big win.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Software Developer (San Francisco, CA)
Age: 33 | Gender: other
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 3/20
Statement of Opinion:
- I think digital therapeutics are cool and could be very beneficial aesthetically, but most aren't on my immediate radar.
- I support it if it helps others more.
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 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Factory Worker (Detroit, MI)
Age: 50 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Managing my blood pressure is a priority, and digital options sound promising.
- Any improvement in managing my health simply using my phone would significantly enhance my life.
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 | 6 | 5 |
| Year 20 | 5 | 5 |
Stay-at-home parent (Atlanta, GA)
Age: 39 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- Digital therapeutics could be interesting, but right now, we're doing okay with regular visits.
- Unless it brings significant discounts or improvements, I'm not sure how impactful it will be.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 5 | 6 |
College Student (Miami, FL)
Age: 22 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- If these digital therapeutics can help me manage my anxiety better than waiting for appointments, that would be a major relief.
- I'm optimistic about having more control over my mental health at my fingertips.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Retired (Seattle, WA)
Age: 55 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- I'm unsure how effective digital therapeutics will be since I don't use much technology.
- If it helps others manage pain, it's worth it, but I might struggle with adoption.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 3 | 3 |
| Year 2 | 3 | 3 |
| Year 3 | 3 | 3 |
| Year 5 | 3 | 3 |
| Year 10 | 3 | 3 |
| Year 20 | 3 | 2 |
Student (Phoenix, AZ)
Age: 7 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 13.0 years
Commonness: 3/20
Statement of Opinion:
- My parents have talked about using apps for my asthma after doctor visits, which could be helpful.
- Anything that keeps me playing soccer with my friends is cool.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 8 |
| Year 2 | 9 | 8 |
| Year 3 | 9 | 8 |
| Year 5 | 9 | 8 |
| Year 10 | 9 | 8 |
| Year 20 | 9 | 7 |
Retiree (Birmingham, AL)
Age: 65 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- Prescription digital health would hopefully make my diabetes management easier.
- More immediate health insights would be reassuring without needing constant doctor visits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $500000000 (Low: $300000000, High: $800000000)
Year 2: $450000000 (Low: $250000000, High: $750000000)
Year 3: $400000000 (Low: $200000000, High: $700000000)
Year 5: $350000000 (Low: $150000000, High: $650000000)
Year 10: $300000000 (Low: $100000000, High: $600000000)
Year 100: $250000000 (Low: $50000000, High: $550000000)
Key Considerations
- The variability in state-level implementation of CMS guidance could affect the overall cost and savings projections.
- Equity in access to digital therapeutics could be a challenge, especially across different demographic regions.
- Continual updates and technological improvements in digital therapeutics may lead to fluctuating costs.