Germany’s first reimbursed apps using pharma to sell to doctors
As the first two health apps in Germany can now be prescribed with reimbursement, HBI speaks to their founders about how they will actually get the solutions to patients.
Kalmeda and velibra, apps designed to treat tinnitus and anxiety respectively, were the first two to be eligible for reimbursement under Germany’s digital supply law, introduced by health minister Jens Spahn last year. Both use CBT (cognitive behavioural therapy) but come from very different organisations, a total of two people work for the Kalmeda start-up while velibra is owned by the Gaia Group, a digital therapeutics group that is two decades old and has over 20 FDA compliant products.
The former is partnering with German pharma company Pohl-Boskamp to get its products to patients, telling HBI that its resources are too small to devise a sales strategy. “PB has a very strong direct sales force for doctors in Germany and will do all of the marketing for us, so it’s a good partner,” says co-founder Christof Schifferings. “The benefit for PB is that it has access to a digital health product that offers a real therapy and not just control and monitoring, as one of the first companies in Germany.”
Being able to reach and convince physicians to prescribe digital therapeutics is going to be one of the main challenges for health apps trying to go to market. Kalmeda’s route is likely to be more common than that of velibra’s, as owner Gaia already has a network of 2,000 physicians that it’s been selling digital therapeutics to privately.
“We have what we call an integrated care model where we help the practices to plan care and have digital sales reps to answer their questions. So we already have a network for going to market,” says CEO Mario Weiss. “We work more with independent practices. The large players in the German market are quite limited in their innovation whereas we have some small physician networks that are quite innovative. The physicians, not the hospitals, are really the prescribers.”
App creators will also have to negotiate the pricing. Kalmeda is reimbursed at €166.79 for 90 days treatment. Around 3-5% of the population suffer from chronic tinnitus and 70% of those develop a psychological comorbidity like depression as a result. It’s estimated to cost Germany over €30bn annually accounting for medical treatment and economic damage.
Weiss says health economic data was vital in negotiating the price for velibra, which has a one-time reimbursement of €476 for a minimum 90-day prescription and a round of physical CBT therapy can cost as much as €2,000 for the payor.
Another of Gaia’s apps, deprexis, designed to treat depressive disorders, was found to reduce long-term costs to the statutory insurer. In the largest health economic evaluation of a DTx (digital therapeutic) and with a total of 3,800 patients, researchers at the University of Bielefeld found that total costs in the treatment group decreased by 32% compared to the control group at 13%. “This is about 2.5 times as large and statistically significant,” Gaia said in June. “The cost data were based directly on insurance records, making them more precise and reliable than the self-reported cost estimates used in most other studies.”
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