Loren Bonner
Pharmacists and other clinicians are going to see digital therapeutics (DTx) and prescription digital therapeutics (PDTs) affect pharmacotherapy in the coming years, said Timothy Aungst, PharmD, lead author of a recent paper about PDTs published April 2, 2023, in JAPhA.
DTx are evidence-based, FDA-authorized software to treat or manage medical conditions and are available either via prescription or as nonprescription products. DTx that require clinician initiation and oversight are called prescription DTx (PDTs).
“We will see an increasing number of changes to conditions due to new digital health data that will help adjust therapy in real time, either with a medication or through adjunctive treatments delivered digitally,” said Aungst, who is an associate professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences.
“That is where health care is going,” Aungst said.
Pharmacists, in turn, will have to understand how this technology affects a patient’s medications.
In the JAPhA commentary, Aungst and coauthor Gigi Shafai, PharmD, said that pharmacists will need further education and training on digital health tools such as PDTs, since they may be involved in direct dispensing or support.
“There isn’t much information in the published literature about DTx and PDTs for pharmacists to read about at this time,” said Aungst. “Most published literature is targeted toward payers and health care decision makers, and yet very little toward helping the majority of pharmacists understand what new technological developments are going on in health care.”
Aungst said they wanted to create a resource that any pharmacist could “pick up and understand” if they were new to the topic.
A scenario
DTx and PDTs have unique mechanisms of action and are expanding treatment options beyond traditional pharmacotherapy. They may be implemented on their own or used in combination with a drug and in some cases, may be the only treatment option for a particular disease state.
As an example, Aungst said health care will move toward a point where insulin will be adjusted for patients in real time. In this scenario, a patient would pick up their pen or vial insulin product and go home. At home, their continuous glucose monitoring (CGM) data would interpret their blood glucose in real time. Then, a DTx/PDT product could take that data and tell the patient to adjust therapy based on the results.
“What if the patient now needs more or less due to the platform adjusting therapy faster than traditionally seen in practice? How does that impact billing or payment and what is dispensed, just at the medication dispensing level?” Aungst said.
In that case, “we start seeing some things really change in the patient care approach,” said Aungst.
While this doesn’t address clinical outcomes or medication safety concerns, the concept can be applied to many other conditions.
What can pharmacists do now?
Although digital health won’t become widely used overnight, Aungst said steady changes will be noticeable.
“We create new technology, generate evidence, get regulatory approval, and clinical guidelines adopted. But it can take years,” said Aungst. “I look at diabetes and CGM and how we are adopting new terms in diabetes care due to that technology adoption. It took a lot of years, but to facilitate just reading CGM data and then implementing the data into practice is where we see novel technologies like DTx/PDTs adopt them to transform how we conduct care.”
He envisions a closed-loop system for insulin, with a CGM plus DTx/PDT plus insulin delivery device all working together.
“Systems for other conditions like hypertension are sure to follow,” said Aungst. “And I think this really changes up how patients, providers, and pharmacists all look at disease management going forward.”
Aungst said pharmacists can expect to find more material coming out on this topic—in many publications as well as in continuing education courses. ■
Abbreviations: AI, artificial intelligence; CBT, cognitive behavioral therapy; CM, contingency management; IBS, irritable bowel syndrome; PDT, prescription digital therapeutics; PTSD, post-traumatic stress disorder; VR, virtual reality.
a As of March 2023.
Source: Shafai and Aungst. JAPhA. Published online April 2, 2023.
APhA’s Pharmacy Library page on digital health includes resources on health/technology professional organizations and centers, conferences/events, publications, article, blogs, podcasts, and practice tools/resources. Available at https://pharmacylibrary.com/digitalhealth