A Deepdive into the Payer Perspective of Digital Therapeutics and How DTx Will Set the Standard for Evidence in Digital Health


The Medullan team attended the 4th annual DTx West Conference, held virtually this year on February 23-25, 2021. This year’s focus was digital therapeutics and how the industry can “accelerate digital therapeutics into the hands of patients.” In a 4 part series, our team recorded critical takeaways from select sessions of the conference.


Part 4: “A Deepdive into the Payer Perspective of Digital Therapeutics” and “How DTx Will Set the Standard for Evidence in Digital Health”


Selling digital health to payers is an uphill battle. In the sessions “A Deepdive into the Payer Perspective of Digital Therapeutics” and “How DTx Will Set the Standard for Evidence in Digital Health”, the audience heard from leaders across digital health and payer organizations about the difficulty in gaining reimbursement for digital health solutions.


Three specific challenges that came to the forefront were:


Evidence in DTx has often been rushed and is inconsistent.

As most digital health companies are venture-backed, they must operate under the constraints of their investors, meaning fast time to market is at a premium.  This has resulted in often rushed and inconsistent evidence generation. As Brian Dolen from Exits and Outcomes said during the ‘How DTx Will Set the Standard for Evidence in Digital Health’ panel,

[Digital Therapeutics companies are] approaching evidence like…the Wild West, it is the de facto way of operating.” due to “these digital companies are for the most part, all venture backed, you know, trying to get to market quickly.”


Hard to present value to payers as evidence is so inconsistent amongst solutions

Payers are not sure how to evaluate digital health solutions, not to mention that the evidence from different solutions varies widely. This was summed up well by Jordan Silberman, MD, Ph.D., Director of Clinical Analytics and Research Digital Care Delivery, Anthem, Inc., during the same panel when he said,

I’m always surprised when doing digital health evidence assessments of how idiosyncratic they are, and how each time I find some new issue that I wouldn’t have put on a checklist.”


Even when validated, DTx solutions can be perceived as not being credible.

With flashy technology making headlines, decision-makers have a hard time determining the credibility of digital health overall. As a result, they may not evaluate specific solutions with care. As Theresa Juday, Director, Speciality Innovation, CVS Caremark, said during the “A Deep-dive into the Payer Perspective of Digital Therapeutics” panel,

Some payers don’t want to include these in their benefits; they don’t want to pay for a video game.”


In Summary

Those building digital solutions, or pharma companies developing drug+ treatments, will need to make a compelling case to payers, clearly demonstrating the problem they are solving, interest and engagement from patients and HCPs, and most importantly, the clinical validity of any claims. This will involve finding the right provider and payer partnerships to pilot and validate the solution and continue to iterate and revalidate. Pharma companies, in particular, used to single launches and well-traveled product pipelines, will need to adapt to new product development and evidence generation approaches to be successful.

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