Arlington, VA, April 11, 2024 (GLOBE NEWSWIRE) -- A new report was released by Digital Therapeutics Alliance (DTA) to support health plans efforts to adopt digital therapeutic products (DTx). The report outlines the steps to align all relevant healthcare stakeholders on how to integrate DTx products into their workflows to allow seamless access to patients and their caregivers.
Incorporating DTx products into standard practice has been an expressed challenge for all stakeholders, ranging from provider systems and health plans, to pharmacies, distributors, and pricing compendia. Over the last two years, DTA, NCPDP, and other partners have made significant progress in addressing pain points in the workflow. In January 2023, stakeholders expressed that each stakeholder’s workflow is impacted by the reimbursement model for the product. At that time, health plans were unsure of DTx product placement in pharmacy or medical benefit pathways.
With the reimbursement model as a critical nexus point, DTA was awarded a grant from NCPDP Foundation to research the reimbursement workflows in health plans to provide guidance on which pathway (pharmacy or medical) a prescription model of DTx product belongs in and the logistics behind integration. Point-of-Care-Partners was selected as the research partner on this project due to their extensive experience working with health plans on workflow issues.
Key findings were:
- The pharmacy benefit pathway is generally most appropriate when the product does not include a hardware component and has an NDC to get the product included into the adjudication systems.
- The medical benefit pathway is generally most appropriate when the product includes a hardware component or when the product doesn’t have patient support through a pharmacy.
- When the DTx product is listed in the plan and PBM formularies and is a pharmacy benefit, stakeholder roles and responsibilities are clearly defined and can use existing NCPDP standards through the adjudication process.
- When the DTx product is part of a medical benefit, the process is more manual, which is a known challenge with most other services and products that are covered as a medical benefit.
Additionally, non-prescription DTx products that are covered as an employer sponsored benefit are included in this report. The workflow outlines roles and responsibilities of each stakeholder involved to ensure the patient receives timely communication and access.
To review the full report and detailed workflow graphics - https://dtxalliance.org/wp-content/uploads/2024/03/March-2024-DTx-Integration-and-Workflow-Report_FINAL-1.pdf
About DTA
The Digital Therapeutics Alliance (DTA) is a global non-profit trade association of industry leaders and stakeholders with the mission of broadening the understanding, adoption, and integration of digital therapeutics into healthcare. DTA works to enable expanded access to high quality, evidence-based digital therapeutics for patients, clinicians, and payors to improve clinical and health economic outcomes. To learn more, please visit: www.dtxalliance.org or follow us on LinkedIn
