Medicare proposes payment for digital mental health therapies
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Medicare for the first time is proposing to reimburse doctors for digital mental health therapies like apps and software to treat behavioral health conditions.
Why it matters: The move could be a boost for digital therapeutics like wellness apps or video games that have been slow to gain adoption because there aren't consistent payment and coverage pathways.
The big picture: The Centers for Medicare and Medicaid Services last week proposed creating three new payment codes that would allow physicians to get paid for incorporating digital therapies into patients' mental health treatment, starting in 2025.
- The codes would only apply to products approved by the Food and Drug Administration.
Between the lines: Insurers have so far been reluctant to pay for apps, video games and other therapeutic software. There isn't long-term data on the effectiveness, and differences in the therapies make it difficult to standardize billing.
- The first company to get FDA clearance for a digital therapy, Pear Therapeutics, declared bankruptcy last year after struggling to secure insurance coverage for its products.
Medicare often sets the standard for what other insurers cover, and advocates say this proposed policy would pave the way for broader coverage of digital mental health treatment.
- "That code being created, I cannot emphasize how awesome that is," Andy Molnar, the CEO of the Digital Therapeutics Alliance, told Stat.
Reality check: The payment codes may ultimately apply to only a handful of digital therapies.
- "This proposal encompasses only part of what may be a spectrum of broadly similar products, most of which might require a new statutory Medicare benefit category," the proposed rule states.
- Still, "it is clear that CMS is enabling progress by focusing on the possible," said Saira Sultan, president of Connect 4 Strategies, a boutique consultancy working with digital therapeutics companies.
