min read
August 2, 2021

Integrate digital therapeutics into the pharmacy pathway

Effective mental health care via your PBM, faster and easier than ever.

Benefits leaders are the unsung heroes of corporate America — ensuring that thousands of members can access their benefits quickly and seamlessly. Unfortunately, the pandemic has only made their jobs more challenging.

As the mental health crisis continues to worsen and new services hit the market at staggering rates, the task of evaluating mental health benefits is more overwhelming than ever. Fortunately, there’s a faster (and easier) way to cut through the noise: working with your pharmacy benefit manager (PBM) to offer safe and effective digital therapeutics for mental health to your members.

Evaluated to be safe, secure, & effective

According to the Digital Therapeutics Alliance, digital therapeutics are defined as “clinically evaluated software that delivers significant health outcomes and can be provided alongside medications.” Given the intrinsic advantages of software — such as scalability and consistency — digital therapeutics can provide effective behavioral care to more people in need. Combine those advantages with a distribution model that’s integrated into existing care pathways and you can seamlessly provide mental health care to your members in need, faster and easier than ever before.  

By opting for digital therapeutic coverage via your PBM, evaluating, contracting, and billing can be managed as easily as medications. Each digital therapeutic offered through this new channel undergoes a rigorous evaluation process ensuring that they have proven clinical outcomes, adhere to strict privacy and security regulations, and will help drive down health care costs. Meaning you have 1, 2… or 10 less hoops to jump through in order to offer your members a safe and effective non-drug alternative for mental health.

Streamlined contracting and implementation

Mental health benefits are only one small piece of the full benefits package pie. And redlining 50+ pages of MSA’s and SOW’s for each new benefit can create an unnecessary administrative burden. By offering digital therapeutics through the pharmacy pathway all that’s required is completion of a simple election form to provide coverage to your members.

From there, providing access to the therapeutics are turnkey — taking advantage of pre-existing pharmacy systems (i.e. no need to collect and send eligibility files). This new approach to offering digital therapeutics for mental health allows members to access care throughout the existing care pathway, whenever they need it most.

Reimbursement, reimagined

Instead of dipping into a tightening wellness budget, you can pay for digital therapeutics for mental health via your pharmacy invoice, drawing from the pharmacy budget if you choose. Claims are processed just like a medication on the formulary, and you’re only billed when a member starts the therapeutic.

In this time of heightened need, it has never been more important to provide access to evidence-based care quickly and easily. This innovative new way to offer digital therapeutics allowed one client to offer Sleepio, a digital therapeutic for poor sleep, in just ten days:

“With the growing number of solutions in the market, securing the necessary budget and the contracting process can both be burdensome. With only a one-page form and streamlined billing through the pharmacy budget, we were able to get the approvals we needed to launch in just 10 days — it was a simple process.”

Lynne Haney, benefits manager at AmeriGas

We believe the future of mental health care is one that increases access and creates less friction for benefits teams. With the way this new pathway changes contracting, coverage, and reimbursement, we hope to help millions back to good mental health — faster and easier than ever before.

Read more about our partnership with a leading pharmacy benefits manager (PBM) in our press release.

US Disclaimer: In accordance with FDA’s Current Enforcement Discretion Policy for Digital Health Devices for Psychiatric Disorders, for patients aged 18 years and older, who are followed by and diagnosed with Insomnia Disorder or Generalized Anxiety Disorder by a medical provider, Sleepio and Daylight can be made available as an adjunct to their usual medical care for Insomnia Disorder or Generalized Anxiety Disorder, respectively. Sleepio and Daylight do not replace the care of a medical provider or the patient’s medication. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for these indications. Users are directed to not make any changes to their prescribed medication or other type of medical treatment without seeking professional medical advice.

UK Disclaimer: In the UK, Sleepio and Daylight are CE marked medical devices available for the treatment of Insomnia Disorder and Generalized Anxiety Disorder, respectively.

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