Pear Therapeutics announced Wednesday that Massachusetts’ Medicaid program plans to cover its digital prescription therapeutics for treating substance and opioid use disorders, reSET and reSET-O.
The decision to cover the digital therapeutics under MassHealth is subject to federal and state approval as well as the availability of funding.
“We applaud MassHealth for their leadership in introducing PDTs to their Medicaid population to provide safe and effective treatment options for patients in recovery,” Pear President and CEO Dr. Corey McCann said in a statement.
“Pear is proud to help fight addiction in Massachusetts, especially at a time when the COVID-19 pandemic is exacerbating the addiction crisis in America with national drug overdose deaths increasing by almost 30% in 2020.”
WHY IT MATTERS
There’s a large market available for digital therapeutics if they can receive reimbursement through public payers.
More than 80 million people in the U.S. receive health insurance through Medicaid or the Children’s Health Insurance Program (CHIP), according to enrollment trends from the Centers for Medicare and Medicaid Services released in June. Nearly 9.9 million people enrolled between February 2020 and January 2021.
Dr. Andrey Ostrovsky, managing partner at Social Innovation Partners and former chief medical officer of the U.S. Medicaid program, said clinical trial evidence and outcomes data are key to getting buy-in from Medicaid programs.
“The punch line if you take nothing else away from this, if you are trying to sell into Medicaid, is to have Medicaid [beneficiaries] in your sample when you are doing research. Real-world evidence is nice to have, but you need randomized control trials,” Ostrovsky told a panel last month at DTx East in Boston.
Other countries have taken steps to ensure reimbursement for digital therapeutics. In 2019, Germany passed a provision that allows doctors to prescribe health apps to patients and get paid through the country’s statutory health insurance.
“At the German Ministry of Health, we have a very broad approach of digitalization of health,” Jan Hensmann, head of the unit for e-health intelligence for the German Ministry of Health, said during a panel discussion in February.
“We’ve been really pushing this topic over the last three or four years in different areas. Let me make this point. I think with digitalization of healthcare you have to take an overall perspective. It all has to come together – it’s the industry, it’s healthcare, it’s professionals, it’s patients.”
Meanwhile, the Scottish government announced today that adult residents will have access to Big Health’s Daylight and Sleepio digital therapeutics for anxiety and insomnia through the National Health Service.
“The COVID-19 pandemic has only affirmed what we knew from the beginning – digital mental health is critical to help scale much-needed services and provide additional choice for people to manage their mental health,” Scotland’s Mental Wellbeing and Social Care Minister Kevin Stewart said in a statement.
“After assessing the effectiveness of Daylight and Sleepio, we are pleased to launch these treatments nationwide, providing clinically validated solutions for those who need it most.”
THE LARGER TREND
Pear has conducted several studies to measure the impact and cost-effectiveness of reSET-O. A study published last month found a “refill” of the digital therapeutic was associated with high levels of abstinence from opioids and treatment retention as well as fewer hospital encounters.
Another study from August found reSET-O alongside counseling and buprenorphine lowered costs of treating opioid use disorder compared with traditional treatment alone.
Pear recently raised a total of $100 million in Series D funding for securing reimbursement options for its products.
In June, Pear announced plans to go public through a $1.6 billion special purpose acquisition company (SPAC) merger.