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Congress·In Committee

Congress Proposes Medicare and Medicaid Coverage for Prescription Medical Apps and Software

Access to Prescription Digital Therapeutics Act of 2025

10 months ago·View on Congress.gov

Legislative Progress

✓ Filed
Review
House
Senate
President

Key Points

  • This bill would allow Medicare and Medicaid to pay for "prescription digital therapeutics." These are software programs or mobile apps that doctors prescribe to help treat, manage, or prevent specific medical conditions like diabetes or chronic pain.
  • Millions of seniors on Medicare and low-income individuals on Medicaid would gain access to these high-tech treatments. Currently, many of these apps are not covered by government insurance, which can make them too expensive for many people to use.
  • The government would be required to set up a payment system for these apps by 2026. To ensure the price is fair, companies that make the apps must report what they charge private insurance companies, or they could face fines of $10,000 per day.
  • By covering these digital tools, the policy aims to give patients more ways to manage their health from home using smartphones or computers. This could help people stay on top of their medical needs between doctor visits.
HealthcareTechnology Digital

Impact Analysis

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Milestones

2 milestones2 actions
May 8, 2025House

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

May 8, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

Within 2 years of enactment

Permanent billing codes established for digital therapeutics

The government would create specific billing codes so that doctors and companies have a standardized way to bill Medicare for these products, making the payment process smoother.

Related News

5 articles
Fierce Healthcare·10 months ago

Access to Prescription Digital Therapeutics Act reintroduced in Congress

Senators Shelley Moore Capito and Jeanne Shaheen reintroduced the Access to Prescription Digital Therapeutics (PDT) Act to expand Medicare and Medicaid access to software-based treatments. The bill aims to create a new benefit category for FDA-cleared apps treating conditions like autism and PTSD.

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Psychiatric Times·9 months ago

Senators Reintroduce Access to Prescription Digital Therapeutics Act

Bipartisan legislation has been reintroduced to increase access to prescription digital therapeutics (PDTs) by creating a Medicare reimbursement pathway. Advocates are using new economic data from Germany to address previous concerns regarding the potential multi-billion dollar cost to Medicare.

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Wall Street Journal·10 months ago

Digital Health Startups Seek Path to Medicare Coverage

Startups developing software-based disease treatments are pushing for federal legislation to overcome reimbursement hurdles. The Access to Prescription Digital Therapeutics Act would require CMS to establish payment methodologies for apps prescribed to treat chronic and behavioral conditions.

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Source Information

Document Type

Congressional Bill

Official Title

Access to Prescription Digital Therapeutics Act of 2025

Bill NumberHR 3288
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(9)
D: 6R: 3

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.