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AMCP Podcast Series - Listen Up: Jennifer Graff Senior Director of Professional Affairs of AMCP
Show Notes
Health care expert Fred Goldstein, host of the AMCP Podcast Series — Listen Up! sits down with Jennifer Graff, Senior Director of Professional Affairs at AMCP to discuss the rapidly evolving field of digital therapeutics, its impact on managed care pharmacy, and important developments to look for in 2023. What are digital therapeutics? How is managed care pharmacy evaluating and approaching them? In a system familiar with pills, tablets, and specialty medications, what system changes are needed to enable patient access to high-quality, cost-effective therapies and ultimately improve patient health? Join us to stay informed about the latest digital therapeutics and managed care pharmacy trends and innovations.
Want to learn more about digital therapeutics? Join us for the upcoming AMCP Summit: Deep Dive into Prescription Digital Therapeutics.
Transcript
[SPEAKERS: Fred Goldstein, Jennifer Graff]
Fred Goldstein 00:02
Hello and welcome to the AMCP podcast series. Listen up. As we take a deep dive into the challenges, trends, and opportunities in managed care pharmacy, follow the show's social hashtag #AMCPListenUp. And to learn more about AMCP, visit amcp.org. I'm your host Fred Goldstein. Today, our guest is Jennifer Graff, the Senior Director of Professional Affairs at AMCP. Jennifer, welcome to the show.
Jennifer Graff 00:31
Thank you, Fred, for having me today.
Fred Goldstein 00:33
Today we'll be discussing digital therapeutics and their implications for managed care and 2023. So Jennifer, could you highlight or define what a digital therapeutic is?
Jennifer Graff 00:43
Digital therapeutics are software applications. They're prescribed by licensed healthcare professionals to offer software-based intervention to treat or manage a condition that could be standalone or they could be used in addition to other existing therapies. And we've seen them in really important clinical conditions such as substance abuse, opioid use disorder, depression, anxiety, etc. So they have more evidence than your typical digital health app or something that you might be monitoring on your Fitbit or phone.
Fred Goldstein 01:17
So similar to pharmaceuticals, these have to go through some sort of an FDA approval process.
Jennifer Graff 01:24
That's correct. For prescription digital therapeutics, they're reviewed by the FDA as a software, as a medical device. So they go through and receive either FDA clearance or market authorization, slightly different evidence standards than a drug, but still have key pivotal trials, such as a randomized clinical trial, as well as oftentimes real world evidence that's going to be needed.
Fred Goldstein 01:50
They are reviewed, they get approved, etc. So how is managed care beginning to look at these products?
Jennifer Graff 01:55
Managed Care is really starting to think about how do they want to offer digital therapeutics, will they be part of the existing formulary and just one of the many interventions that prescribers prescribe. Some other managed care organizations are beginning to think about these as part of their broader wellness and digital health formulary. And so each organization is starting to tackle this on their own in their own unique ways. What we do know when we survey our managed care members at AMCP, we found that about eight out of 10 plans are beginning to think about what their strategy is, over the coming 12 to 18 months. Now, what does this actually mean? This is translated into a couple of pretty big announcements in late 2022 and early 2023. Let me give you a couple of examples. South Carolina recognized that opioid use and substance use is a really important challenge that they deal with. And so South Carolina Department of Corrections announced a plan to offer prescription digital therapeutic for substance use and opioid use disorder for their inmate population. Taking the existing tools that we have today, and ensuring that patient outcomes are maximized. Now we're also seeing some things in Medicaid, where this is also being picked up Florida Medicaid, the third largest Medicaid plan in the United States; set of plans in the United States, recently announced in early January that they'll be offering some prescription digital therapeutics as part of their preferred drug list. Now, that's really important because for Medicaid patients to receive a treatment and have access, being on that preferred drug list or PDL is a critical part for them to be able to be prescribed and actually, then go and obtain the medications and treatments that they need.
Fred Goldstein 03:56
And I would assume I mean, this is really good news because people have difficulty particular Medicaid, we always deal with the issue of how do you go fill your prescription, you know, and getting there and access to transportation, etc. But this is really something that's a therapeutic on your phone. And really the as we know the majority of Medicaid beneficiaries have telephones, and they have access to the internet so they can use these apps.
Jennifer Graff 04:19
Absolutely. These prescription digital therapeutics offer not only an opportunity to close the gap for patients in the Medicaid population, but when you think about patients in underserved communities, where there may not be sufficient mental health professionals, or where you're in a geography and rural population, where you have to drive a long way to go and see a provider. Being able to access, download these tools, have a virtual reality headset and undergo your therapeutic interventions at home or amidst your busy day has the potential to really improve patient care and make it as easy as possible for patients tends to engage in their care plans.
Fred Goldstein 05:02
Jennifer, you've talked about Medicaid, Corrections. What about the commercial market?
Jennifer Graff 05:06
The commercial market is where we're seeing the largest uptake, partly because they have a much broader opportunities to engage in treatments there. And so what we're finding on the commercial side is that several of the large PBMs or pharmacy benefit managers have started to adopt certain prescription digital therapeutics, either as part of their formulary or as a digital health formulary. And so they offer that either as an add on benefit for employers or health plans to purchase, or it might be part of the standard offering. And so what we're beginning to see is, as more and more commercial health plans are offering and PBMs are offering prescription digital therapeutics, this is going to be a differentiator when they're reaching out and signing contracts with employers for their 2024 insurance benefit offerings. And anytime you start having market differentiators and employers and employer groups start asking for this information that starts to drive market demand, market awareness, market adoption. Now are employers there yet? Maybe not. They have a lot that they're dealing with coming out of COVID. But I could imagine a world where if you want to keep employers happy, and you have a family member that might have a mental health or substance use health disorder, many of them are going to be thinking about any way they can do to make sure that their employees life, and their home life is as easy as possible.
Fred Goldstein 06:38
And you mentioned something interesting, you use the phrase, obviously, a formulary. And then you use this digital formulary. What are some of the issues that made you say that or that people need to consider as they look into the digital world versus the standard pharmaceutical formulary world.
Jennifer Graff 06:54
Right, so many of them, I think will begin to see in 2023, more and more of these digital therapeutics on the prescription formulary. It makes monitoring and tracking much easier. For the health plan. It also is a similar approach that that providers and patients are used to. The challenge or the benefit with both digital health formulary is that it's an added offering, it's easier to be an add on or ala carte for an employer that might want to be testing or piloting new product offerings. But one of the key challenges when you don't have it as part of your prescription drug formulary is are all of the bells and whistles and pipes to ensure everything from the prescriber prescribe some medication or the digital therapeutic, the patient receives it. It's coded and included in claims database, the health plan can evaluate how effective that treatment was. All of those things are much harder when they're in standalone benefit categories.
Fred Goldstein 08:00
And what about the issue of a review in just in terms of its technological approach and the safety of data sharing, etc.?
Jennifer Graff 08:10
It's really important question, these new treatments offer many insights and opportunities. So traditionally, for our drug pharmacy and therapeutic committees are groups of healthcare professionals, who are responsible for evaluating and making recommendations about the treatments that will be covered by a health plan. Now, these committees often are made up of clinicians and may not have all of the IT and data security expertise. If you might cover one of these medications, you'll be looking at data integrity, especially on mental health and substance use disorders. Be wanting to think about a lot about HIPAA, you need to ensure that the data integrity is there as well. And so there's a lot of nuances. While these are new opportunities, they also provide new challenges for us to learn and expand our understanding of this digital world.
Fred Goldstein 09:05
And one of the areas that I was thinking about is when I go to fill my prescription is you sign... was I educated, was I provided the education, if so, how is that going to fit, or what's the role there with the pharmacists in that?
Jennifer Graff 09:17
The pharmacists have an important role to play. So traditionally, or how many of these digital therapeutics are offered is there a prescribed you might get a sample and they're offered through a specialty pharmacy that has unique training on digital therapeutics. counseling for a new app, or wearable is a little different than counseling on how to use a pill that you might take three times a day or a cream that you apply to an affected area. And so there's new training opportunities for pharmacists. There's also a lot of other opportunities to embed these prescription digital therapeutics into many of the resources that pharmacies are used to and pharmacists and managed care pharmacists are used to using. Let me give you a couple of examples. Drug Compendia are really critical reference book or database that contains information about the therapeutic products. And so it is part of that system everywhere from prescribing to looking at dosing and checking to ensure that you have the right dosing and prescribing information, to reimbursement and even evaluation. Up until recently, most of the digital therapeutics are not included in the existing core Compendium. They were included in a device Compendium that often may not be part of what a pharmacist or a pharmacy would subscribe to. So they've been completely integrated now into these drug databases, these drug Compendia databases, and I think there's more work to be done. But that was an important first step in late 2022. That can help encourage pharmacists to have the tools and information that they need to help in that prescribing and counseling for the patients.
Fred Goldstein 11:07
So these digital therapeutics provide some new wrinkles into how the system might function. I understand you're gonna be doing a summit in June, can you talk a little bit about that?
Jennifer Graff 11:18
That's correct. As part of AMCP's initiatives to provide resources for health plans and others to evaluate digital therapeutics AMCP will be convening a summit to bring together thought leaders share novel and unique experiences, what their tried and true, tested approaches are to managing these new opportunities. So you can join us on June 1 2023, virtually, from 10:00 to 4:00 at the AMCP Summit: Deep Dive on Prescription Digital Therapeutics.
Fred Goldstein 11:53
And I assume there'll be able to find this up on amcp.org.
Jennifer Graff 11:57
You can find this information at amcp.org under the calendar and AMCP Summits. We can include this also in the show notes.
Fred Goldstein 12:06
So really exciting area. Obviously, it sounds like there's a lot of enthusiasm for this new category is that what you're picking up?
Jennifer Graff 12:12
As managed care professionals, we're working to improve patient health. And by doing so we need to make sure that we have the highest quality and most cost-effective treatment options available. Together by working with our health plans, patients, providers, and others, we can bring digital therapeutics into this brave new world.
Fred Goldstein 12:32
Well, that's really a great way to finish the show, Jennifer, and thank you so much for joining us today and discussing AMCP work and digital therapeutics.
Jennifer Graff 12:39
Thank you for having me.
Fred Goldstein 12:42
And thank you for joining us today. If you like the show, you can find all our episodes at amcp.org/podcast on our show page at healthcarenowradio.com or on your favorite listening platform by searching HealthcareNOW radio. You can follow our show on social at #AMCPListenUp. And don't forget to share, like and follow AMCPorg on LinkedIn, Twitter, Instagram and Facebook. I'm Fred Goldstein for AMCP. Until next time.
About the Hosts
Fred Goldstein is the founder and president of Accountable Health, LLC, a healthcare consulting firm focused on population health, health system redesign, new technologies and analytics. He has over 30 years of experience in population health, disease management, HMO, and hospital operations. Fred is an Instructor at the John D. Bower School of Population Health at the University of Mississippi Medical Center and the editorial Board of the journal Population Health Management.
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