ATA Action, the advocacy arm of the American Telemedicine Association, is supporting a new bipartisan bill that could bring FDA-authorized prescription digital therapeutics (PDTs) under Medicare and Medicaid coverage. The Access to Prescription Digital Therapeutics Act would require the Centers for Medicare & Medicaid Services (CMS) to establish payment models and assign product-specific codes, enabling reimbursement and access for millions of Americans with chronic and complex conditions.
Evidence-based software programs, known as prescription digital therapeutics, treat, manage, or diagnose health conditions. These FDA-cleared tools are available 24/7 through smartphones, tablets, or computers, making them highly accessible for underserved populations.
What the new bill would do
The legislation, which has bipartisan, bicameral support in Congress, aims to:
- Define PDTs as a covered benefit under Medicare and Medicaid
- Direct CMS to assign HCPCS (Healthcare Common Procedure Coding System) codes
- Develop reimbursement frameworks to ensure consistent access and coverage
- Support equitable access to clinically validated digital treatments
This bill builds on earlier efforts, such as the 2020 Prescription Digital Therapeutics to Support Recovery Act, by creating a permanent benefit category for digital therapeutics.
Why digital therapeutics matter for federal health programs
For Medicare and Medicaid beneficiaries—often low-income, older, or disabled—PDTs can close persistent care gaps. These tools help patients manage conditions without relying on in-person visits, making care more accessible and scalable.
“Digital therapeutics deliver medical interventions directly to patients, closing gaps in care caused by unmet patient needs, provider shortages or economic or geographic disparities,” said Andy Molnar, head of digital health at ATA Action.
PDTs are already being used to treat a range of conditions, including:
- Substance and opioid use disorders
- Mental health conditions
- Diabetes and metabolic diseases
- Stroke recovery and neurological issues
- Cancer-related symptoms
- Women’s health and chronic pain
- Alzheimer’s disease (in development)
Broad support from Congress and health advocates
The bill has been reintroduced by Senators Shelley Moore Capito (R-WV) and Jeanne Shaheen (D-NH), and Representatives Kevin Hern (R-OK) and Mike Thompson (D-CA). ATA Action applauded their leadership and noted the legislation’s potential to improve health outcomes and system efficiency.
“This legislation underscores the clinical and health economic value that PDTs can provide,” said Molnar.
A broader digital health policy push
The legislation is part of a larger policy agenda led by ATA Action, which recently absorbed the Digital Therapeutics Alliance (DTA) and launched the Advancing Digital Health Coalition. This coalition is focused on:
- Supporting FDA’s guidance on Prescription Drug Use Related Software (PDURS)
- Advocating for coverage of Digital Mental Health Treatment (DMHT) devices
- Advancing remote monitoring technologies and AI-enabled diagnostics
- Promoting tools that support care at home and patient self-management
“One of ATA Action’s top priorities is to work with policymakers to ensure this legislation passes,” added Kyle Zebley, executive director of ATA Action.
Key takeaways
- A new bill could formally include digital therapeutics under Medicare and Medicaid coverage
- PDTs treat chronic and behavioral health conditions using FDA-cleared software
- The bill has bipartisan support and aims to increase access and reduce systemic care barriers
- ATA Action and its coalition are actively advocating for digital health integration into public healthcare systems
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