The news: Pear Therapeutics launched a new program to help substance use disorder (SUD) patients find virtual or in-person physicians.
What this means for Pear: Telehealth could improve access to addiction treatment, which could boost Pear’s enrollment.
Many (46%) addiction treatment physicians say telehealth is equally or more effective than in-person treatment, according to a recent study of 100 California clinicians.
Telehealth could also make it easier for SUD patients to see a specialist or attend events like group counseling. That would encourage more patients to try Pear's digital therapeutics (DTx) programs, as seeing a specialist makes them more likely to receive a doctor’s recommendation for the DTx.
What’s next? Easier coding and better Medicaid coverage could spur physician adoption of digital therapies—which generally remains low.
Physicians are responsible for prescribing digital therapies. But some physicians aren’t ready to accept these tools in clinical practice.
But this can change as it becomes easier for physicians to bill insurers for digital therapies like Pear’s. For example, on April 1, the CMS established the Healthcare Common Procedure Coding System (HCPCS) Level II code. This makes it easier for insurers to process claims and pay physicians for procedures associated with DTx. And doctors will be more likely to prescribe DTx tools if they’re confident in the claims reimbursement process for recommending these tools.
Plus, large Medicaid payers are warm to Pear’s programs to cover it as a benefit in their health plans. Last year, MassHealth (Massachusetts’ Medicaid program) said it plans to cover Pear’s prescription SUD therapies, for example. Lower out-of-pocket costs for patients will also make it more likely for doctors to recommend DTx tools.
Pear’s Massachusetts Medicaid partnership could be the first step to getting therapies like Pear in the hands of millions of patients: US Medicaid covers 80 million individuals, which is nearly double the size of major commercial insurers like United Healthcare.