Have DiGAs fully established themselves in everyday German healthcare?
Since the Digital Healthcare Act (Digitales Versorgungsgesetz-DVG) came into force on December 19, 2019, digital health applications (DiGAs) can be prescribed by doctors and psychotherapists and reimbursed by health insurance companies.
The German healthcare system has thus taken on a (rare) pioneering role in international comparison. Other countries, such as Belgium or France, have begun to implement similar models with the aim of promoting digital innovations and enabling new approaches to better and more comprehensive patient care.
However, looking at the number of prescriptions to date (around 375,000 in total since the DiGA program began) and the resulting user numbers and acceptance by the medical profession, it is clear that DiGAs have not yet really arrived in the German healthcare system and in everyday care.
Why are DiGAs still struggling in patient care - challenges and opportunities for DiGA manufacturers
In addition to the issues surrounding the approval procedure (fast track), which allows DiGA manufacturers to be reimbursed for 12 months even without an initially proven benefit, and the special pricing structure (manufacturers can set their prices for the first 12 months), the following points in particular are fueling the public debate today:
How can potential users be made aware of DiGA?
The majority (more than 70%) of DiGA users are referred to DiGA by their practitioners.
With budgets often tight, DiGA manufacturers need to find ways to inform and motivate practitioners to consider DiGAs as an alternative & supplementary treatment and to recommend and prescribe DiGAs to their patients. This also includes conveying realistic expectations on the part of patients as to what a DiGA can achieve and what action and contribution is required from patients.
How can access to DiGAs and their use be supported?
Unlike with prescription drugs, patients must first submit their DiGA prescription to their health insurance provider in order to receive an activation code for their DiGA. Both when submitting the prescriptions and when subsequently using the activation codes sent to them, prescriptions often fall by the wayside and are not used by patients in the first place. The number of unused prescriptions or activation codes varies depending on the illness and the corresponding DiGA - according to estimates by various DiGA manufacturers, however, this rate can be as high as 50%.
DiGA manufacturers have the opportunity here to help patients with support offers for submission and to motivate them to redeem the activation codes. From the beginning of next year, it will also be possible to prescribe a DiGA via e-prescription, which will probably make it easier to use.
How can DiGA users be motivated to use the apps for the entire prescription period?
The survey carried out by Barmer health insurance showed that a significant number of DiGA users (38%) stop using the app before 90 days have elapsed (15% already during the first month).
The lack of adherence is increasingly being criticized by both insurers and legislators. It is therefore expected that DiGA manufacturers will be confronted with an amendment to the law by the end of the year, which will only allow reimbursement if a minimum usage period is reached. It remains to be seen to what extent user support, e.g. in the form of adherence programs, will be included in approvals and reimbursements.
DiGA manufacturers should address the issue of adherence support now in order to prevent a future reduction or elimination of reimbursement.
What will the future of DiGA look like in Germany and what does this mean for manufacturers?
There will certainly have to be a readjustment of DiGA legislation so that DiGAs can better fulfill its role as a digital driver.
For DiGA manufacturers, this means, among other things, the need to focus more on the topics of user support, guidance and adherence.
At the same time, this is of course also an opportunity for manufacturers to differentiate themselves at an early stage by integrating and using appropriate adherence solutions and offerings and to secure existing business models.
If you want to learn more about how to successfully establish your DiGA and fully exploit & sustain its value to patients and clinicians, please reach out to us.
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