对数字治疗药物的保险覆盖的洞察:对美国付款人观点的定性研究
Ainhoa Gomez Lumbreras1, Jason T Hurwitz2, Xi Liang3
1Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City.
Journal of managed care & specialty pharmacy
|March 31, 2024
概括
医疗保险支付人需要强有力的证据证明数字疗法 (DTx) 覆盖的有效性. 关键障碍包括政策修订和计费机制,其中心理健康DTx显示出最有希望的报销.
科学领域:
- 数字疗法 (DTx) 是医疗保健中一个不断增长的领域,需要明确的覆盖路径.
- 了解付款人的观点对于将DTx纳入医疗保险福利至关重要.
背景情况:
- 数字疗法 (DTx) 的开发和营销急剧增长,但医疗保险覆盖范围在很大程度上仍未确定.
- 付款人面临着越来越大的压力,需要为这些创新医疗产品制定保险政策.
研究的目的:
- 调查影响数字疗法 (DTx) 医疗保险覆盖决定的因素.
- 了解美国付款人和保险决策者关于DTx报销的观点.
主要方法:
- 定性,横截面研究,涉及虚拟焦点小组和采访医疗保险决策者.
- 对编码成绩单的分析,以确定与DTx证据和覆盖障碍相关的主题.
主要成果:
- 与传统药品相比,有效性的证据是DTx覆盖的首要要求.
- 确定的障碍包括政策修订需求,非处方药产品排除和计费机制挑战.
- 对心理/行为健康的数字治疗被认为是最有可能获得补偿的,可能是在药店或医疗福利下.
结论:
- 有效性的证据是数字疗法医疗保险覆盖的关键先决条件.
- 支付人对DTx融入现有健康福利结构表示不确定性.
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