The research found the following key themes regarding commercial payer coverage of digital medicine:

Lack of coverage alignment across commercial payers, Medicare and Medicaid. Commercial payers trail Medicare in the coverage of digital medicine services explored by the research. Medicare and Medicare Advantage plans cover all 21 digital medicine services. However, private Medicare Advantage plans do not offer the same coverage in the commercial market. Coverage by Medicaid is more limited, although it has been expanding over time.
Inconsistent coverage policies within the commercial market. Among the digital medicine services explored by the research, most commercial payers cover remote physiologic monitoring, while several still are considering coverage of the newer remote therapeutic monitoring. Coverage of electronic consultations and electronic visits is less consistent.
Transparency of coverage policies for digital medicine services is highly variable across commercial payers. Although some plans have publicly available clinical coverage policies related to digital medicine services, many have no publicly available information, or the information that is available is difficult to access or dated.
Time lag for determining coverage policies within the commercial market. Commercial payers contend there is no specific timeline for reviewing and making coverage decisions about the digital medicine services explored by the research. It can be several years before a digital medicine service is covered by a commercial payer, creating uncertainty and complicating planning and investment in digital health programs.

Limited widespread utilization of most new digital medicine services. Commercial payers contend that a limited number of health care professionals leverage the digital medicine services explored by the research. Payers are eager for more information on the impact and quality of digital medicine services to inform coverage decisions.
Partnerships between commercial payers and health tech companies. Commercial payers are partnering with health tech companies to provide direct access to digital services for specific disease areas. Although these programs offer access to innovative digital health solutions, they often are disconnected from a patient's medical home or existing primary care physician, which can further fragment care.

"Barriers to clear and consistent coverage policies must be addressed for the pace of digital health progress in medicine to match the technology's promising potential," Ehrenfeld said.

Instant Insights /

AMA research finds inconsistency in insurance coverage for digital medicine

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