Access to Prescription Digital Therapeutics Act of 2025
Congress Proposes Medicare and Medicaid Coverage for Prescription Medical Apps and Software
Stalled
No legislative action in over 90 days.
Legislative Progress
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.
Impact Analysis
Personal Impact
Life & Work
Small companies that develop FDA-cleared digital therapeutics would gain access to a massive new customer base through Medicare and Medicaid. The bill creates a formal payment system and product-specific billing codes, which would make it much easier for these companies to get paid for their products. However, they would also face new reporting requirements and potential fines of up to $10,000 per day for inaccurate reporting.
Programs
Disabilities
Milestones
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.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in House
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
5 articlesAccess 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.
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.
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.
Source Information
Document Type
Congressional Bill
Official Title
Access to Prescription Digital Therapeutics Act of 2025
Data Sources
Sponsor
Cosponsors
(9)Analysis generated by AI. Always verify with official sources.