Are Digital Pills Worth It for Benefit Plan Sponsors?

The first digital pill, Abilify MyCite, is a treatment for schizophrenia aimed at improving patient adherence.

Approved by the Food and Drug Administration in November 2017, Abilify MyCite includes an ingestible sensor, a small wearable sensor patch, a mobile app and a web-based portal for use by medical professionals in addition to the medication.

Now, with more digital pills for additional uses on the way, plan sponsors should be asking three questions before including digital pills in their pharmacy benefit plans.

1. Will patients accept the idea of ingesting a pill with a sensor and having their doctor electronically monitor them? News reports of the FDA’s approval of Abilify MyCite included worries about security, privacy and “big brother” watching. Some experts wondered whether hackers could break into the system, obtain a patient’s health records and threaten to expose their medical secrets. Others expressed concern that mentally ill people or individuals deemed incompetent might be forced to use digital pills against their will. It remains to be seen if patients will welcome or be wary of digital pills.
2. Are there less intrusive ways to address the problems digital pills are designed to solve? While there are many possible uses for digital pills, the health concern driving the development of Abilify MyCite is patient nonadherence — a complex problem for most plan sponsors. We intuitively know that taking life-saving medications as directed is critical to ensuring positive health outcomes. Abilify MyCite addresses nonadherence due to forgetfulness. But for forgetfulness, there are already less-intrusive ways to solve the problem than swallowing an ingestible sensor. One example is digital pill bottle caps that text or alert patients, reminding them to take their medicine.

Further, forgetfulness is the culprit in nonadherence just one-third of the time. Other factors that affect whether patients take their prescribed medications include the high cost of some prescription drugs, physical side effects and psychological barriers. A digital pill that simply informs whether a patient does or does not take their medicine does little to solve these problems.

There is no one solution to the complicated issue of nonadherence — which could explain why plan sponsors have not yet enthusiastically embraced any of the technology solutions designed to solve it.

3. Will digital pills result in health outcomes sufficiently better to justify the extra cost of digital pills over conventional medications? According to news reports, the jury is still out on whether Abilify MyCite helps schizophrenia patients better comply with taking medications as directed, given the nature of the illness. But it has been reported that nine health systems in six states are prescribing digital pills for conditions including hypertension and type 2 diabetes, with positive interim results reported from a randomized controlled study. More research is needed to determine the efficacy of digital pills across a broader range of conditions, and only time with tell if the cost premium is returned in the form of improved outcomes.

These are early days of digital pills. With pharmacy benefit managers and plan sponsors dealing with the larger and more immediate issue of the rising cost of specialty pharmaceuticals, it remains to be seen how much time and effort they will put into measuring where and how digital pills might make a dent in overall pharmacy costs and improved outcomes — if they do at all.

Nadina J. Rosier is the North America health and group benefits pharmacy practice leader at Willis Towers Watson. Comment below or email editors@workforce.com.