Benelux countries make moves on digital therapy reimbursement
The Netherlands and Belgium are closely following behind Germany in reimbursing digital therapeutics (DTx). Payors in the former are negotiating a strategy while the latter has just seen a rehabilitation app become the first to receive public payment.
Belgium is one step ahead of the Netherlands in that a Ghent-founded DTx solution, called moveUP, has recently become the first DTx solution to be reimbursed in Belgium for a temporary period while it carries out a clinical study on +1000 patients in 15 hospitals. The company provides personalised exercise plans for patients following a knee or hip replacement and is one of twenty digital health apps that Belgium is trying to integrate into its healthcare system.
One source working in the DTx space says that policymakers and health insurers in the Netherlands “have no problem” reimbursing the solutions but are still trying to create a framework. “If a doctor in the Netherlands has a protocol then to them it doesn’t matter how that end is met: the treatment can be digital or physical and the consultations can be digital or physical.
“As long as the treatment is covered by the insurance then digital is a fine modality. It’s up to the private companies to accept these products and they seem willing to talk.”
At least one Dutch insurer has formulated a public digital health strategy. Menzis has published its ‘digital health vision’ in collaboration with the Ministry of Health and the healthcare sector, and set up an innovation portal to support the scaling of good initiatives. “Menzis applauds the use of digital care if this contributes to future-proof care with the insured in a coordinating role,” it says.
Belgium’s health minister Maggie De Block has too been a prominent proponent for digital health. A project between medtech representative body beMedTech, Agoria and the health insurers has created a three-tier model for deployment. Any digital health solution (not just DTx) must firstly have a CE mark, secondly, be interoperable with the country’s healthcare system (which has just undergone its own interoperability reform), and thirdly be able to show socio-economic evidence to be publicly reimbursed. 18 apps have reached the first level, one (Comunicare) the second and just moveUP reaching the final.
The moveUP clinical study is assessing the socio-economic impact of the DTx solution as much as the medical, to evaluate whether long-term reimbursement is justified. moveUP claims that it can generate €27m annual savings for the Belgian health insurance administrator INAMI, which is also funding the clinical study. Belgium completed 23.5k hip replacements and 24k knee replacements in 2018.
The trial is due to start in October this year with full reimbursement expected in September 2021. Patients at the 15 hospitals have the option of using the DTx or traditional rehabilitation. INAMI says that reimbursement includes onboarding the patients onto the app, the treatment itself plus any necessary hardware and tech support, and any follow-up treatment whether it’s physical or digital. Patients will face no co-payment, even for the technology.
Jessica Shull, who leads the Europe branch of the Digital Therapeutics Alliance, a body which advocates for the use of DTx, says: “National recognition and public reimbursement for digital medicine and digital therapeutics in European countries is developing quickly. Germany, France, UK, Belgium…these countries are looking ahead and understand the value regulated medical device software treatments can offer their populations.
“This is working as a catalyst for the industry, as well as inspiring established pharma companies. It’s refreshing and essential that countries have frameworks to adopt and finance for these products, as populations grow and doctors’ time is further stretched. We’re working to harmonise recognition across Europe, which is also critical for scalable growth.”
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