The Biden Administration is driving forward an innovative approach to tackling the nation’s substance use crisis by promoting new reimbursement strategies for digital therapeutics for substance use disorder across both public and private health sectors. This priority is detailed in the Administration’s latest National Drug Control Strategy report, which aims to broaden access to evidence-based treatments amid the growing addiction and overdose epidemic.
What Are Digital Therapeutics for Substance Use Disorder?
Digital therapeutics for substance use disorder are clinically validated, software-driven treatments designed to prevent, manage, or treat addiction. These interventions include smartphone apps, web-based programs, and connected devices that provide behavioral therapy, medication reminders, recovery coaching, and monitoring tools.
Unlike general wellness apps, digital therapeutics for substance use disorder undergo rigorous clinical trials and regulatory review. For example, Pear Therapeutics’ reSET was the first FDA-cleared digital therapeutic specifically for SUD, setting a precedent for this emerging field.
Why Reimbursement Matters for Digital Therapeutics
Despite demonstrated benefits, digital therapeutics for SUD have faced reimbursement challenges. Historically, payment policies for these innovative tools have lagged, particularly in government programs like Medicare and Medicaid. Without clear reimbursement, many patients cannot access these effective treatments, and providers lack incentives to adopt them.
The Biden Administration’s plan highlights the need to establish billing codes and reimbursement structures to support digital therapeutics for SUD, especially within contingency management programs that use motivational incentives to improve patient outcomes.
Motivational Incentives and Contingency Management
Contingency management programs, which rely on motivational incentives to reward patients for treatment adherence and abstinence, have proven highly effective in managing substance use disorders. The Administration is pushing to ensure reimbursement for both the incentives themselves and the providers who administer these programs through digital therapeutics for substance use disorder.
By leveraging smartphone apps and smart debit cards, incentives can be delivered automatically and personalized to patient needs. This modern approach helps reduce barriers such as stigma, transportation, and scheduling conflicts.
Key Features of Digital Therapeutics for Substance Use Disorder
Digital therapeutics offer comprehensive functionalities, including:
- Automated appointment and medication reminders
- Remote substance use monitoring (drug, alcohol, nicotine testing)
- Self-guided cognitive behavioral therapy modules
- Virtual recovery coaching and peer support
- Real-time progress tracking and personalized feedback
These features empower patients to engage actively with their recovery journey, increasing the chances of sustained success.
The Bigger Picture: A Comprehensive Strategy
Digital therapeutics for substance use disorder form one critical pillar in the Biden Administration’s broader drug control strategy, which also emphasizes harm reduction, expanded care settings, payment reform, workforce development, and support for vulnerable populations.
This multi-pronged approach recognizes that effectively addressing substance use disorders requires innovation in treatment delivery and financing.
Urgent Need for Expanded Access
The COVID-19 pandemic exacerbated substance use challenges, with 13% of adults reporting new or increased use. Yet, only a small fraction of those needing treatment actually receive it. According to SAMHSA, just 12.2% of individuals with SUD accessed specialty treatment in 2019.
By expanding reimbursement for digital therapeutics for substance use disorder, the Administration aims to close this gap and deliver accessible, evidence-based care to more people.
Progress Toward Reimbursement and Policy Support
Significant progress has been made since the creation of the Digital Therapeutics Alliance (DTA). Many digital therapeutics for SUD are now covered by employers, insurers, and Pharmacy Benefit Managers. However, public programs like Medicare and Medicaid still require formal benefit categories.
In 2021, CMS introduced a new billing code for “Prescription digital behavioral therapy, FDA cleared, per course of treatment,” facilitating coverage decisions. Additionally, bipartisan legislation has been introduced to ensure Medicare coverage for FDA-cleared digital therapeutics.
What This Means for Patients and Providers
Improved reimbursement for digital therapeutics for substance use disorder will enable:
- Greater patient access to flexible, personalized treatment
- Increased provider adoption of evidence-based digital tools
- Reduced stigma by offering remote, confidential care options
- Enhanced integration of behavioral health into broader healthcare systems
These developments promise to transform addiction treatment and improve outcomes nationwide.
Conclusion
The Biden Administration’s commitment to advancing reimbursement for digital therapeutics for SUD reflects a forward-thinking strategy to expand access, improve quality, and tackle the addiction crisis with cutting-edge solutions. As policy reforms continue, digital therapeutics are poised to become a cornerstone of effective, accessible substance use disorder care.
For those affected by addiction, understanding and exploring digital therapeutics for SUD could unlock new paths to recovery and hope.
