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Reimbursement of digital therapies and telemedicine

The term digital therapeutics (Dtx) is not well known in the Czech Republic and there is no legal definition of it yet. Current laws do not deal with the concept or the essence of Dtx. For this reason, Dtx are not included in the legislation that would specifically allow their reimbursement from health insurance. However, there are already discussions in market access circles on how to include software as a medical device in the health insurance reimbursement system and the stakeholders are looking for application of general reimbursement rules on Dtx.

Currently, the only way some Dtx can be covered by health insurance is by registering them as a medical device in the form of software. However, the process of negotiating reimbursement from health insurance is very complex as medical device does not fall under any particular reimbursement mechanism. Thus, there is no specific legal framework that sets out the rules for assessing a Dtx reimbursement request, which leads to different approaches by different insurance companies resulting in selective reimbursement of Dtx.

For example, insurance companies expect software to contribute to addressing the shortage of doctors caused by demographic trends. They evaluate indicators such as savings in staff capacity, reduction in the number of medical devices needed, or increased patient satisfaction. However, the main focus is on concrete evidence of improvements in patient health and the prevention of any subsequent complications. Simply put, insurance companies need evidence-based applications to demonstrate what funds are being spent on and where savings are being made through the use of software. These criteria are assessed on a case-by-case basis.

We are involved in a number of projects aiming at receiving reimbursement in this life sciences topic. As this is complex market access matter, we are working also with data consultants to ensure that your reimbursement application will have a chance at getting the reimbursement.

Need any help? Reach out to us any time.

Mgr. Igor Pieš partner

igor@kastnerpies.cz