Did you know that some medical apps are reimbursed in some countries?
You might be surprised to learn that in some countries, when a doctor prescribes a medical app, the public health system will reimburse the cost of the app. These apps can often help patients manage their conditions more effectively and avoid costly healthcare visits or even hospitalizations.
While digital health apps cannot be considered a complete alternative to traditional medical care, they can be a good complement to it. They can help patients who wish to apply self-care techniques, even though they will not replace the advice of a health care professional. Some apps afford tangible benefits; they are considered on par with drugs and non-drug technologies and are thus treated similarly by public payers.
The case of Germany
In Germany, the public health system will reimburse the cost of some apps prescribed by a doctor or on proof of a specific medical condition. These apps can often help patients manage their conditions more effectively and avoid costly visits to healthcare professionals.
The apps that can be reimbursed by public health insurance are those approved by the Federal Office for Drugs and Medical Devices (BfArM) and listed in their Digital Health Applications Directory (DiGA). This approval is based on an assessment of the app's safety, quality and effectiveness, which entails that the apps have been studied was studied in a patient population. If you are interested in health app research, go ahead and check out this other AppGuide article.
Approved digital health apps are often apps that can be used for the treatment and management of chronic diseases such as diabetes, high blood pressure and depression, and/or that can be used to help prevent disease and support healthy lifestyle habits. The public health insurance in Germany reimburses the cost of these approved digital health apps, if patients meet certain criteria, and if it is prescribed.
What about other countries and Canada?
Some European countries reimburse or are in the process of developing a reimbursement system for health apps, including Belgium, Denmark and the UK.
For now, in Canada, no provincial public health insurance plan reimburses medical apps, with the exception of connected health devices and their apps, such as continuous glucose monitoring devices, or of some rare app (see below for Ontario example).
In Quebec, no information could be found to the effect that the RAMQ (Régie de l'assurance-maladie du Québec) would consider such coverage in the future, or is working to make it possible.
However, if you have a private health insurance, it may be worth asking your health professional if there might be an app that could help you manage your condition better, and if there is, to check with your insurance provider to see if it would be covered under your plan. The cost of an app may be covered by your plan as a regular benefit or under a personal health spending account, if available.
Discover reimbursed health apps in Germany
Here are some examples of apps that are reimbursed in Germany.
The mySugr Diabetes App is a quick and easy way to help manage diabetes. The app makes it easy to track and manage diabetes data, including blood sugar levels, insulin levels, and carb intake. The app also provides insulin/bolus calculator with precise insulin dose recommendations, estimated HbA1c at a glance, daily, weekly, and monthly reports, and secure data backup.
It is approved for medical purposes as a Class I FDA tool, and is certified as a CE Class IIb medical device in Europe.
Cara Care is a gut health tracking app that helps users manage and track conditions like IBS, IBD, GERD, Celiac, dyspepsia, and food intolerances. The app allows users to track their symptoms, food, and poop in order to identify patterns and improve their overall gut health. The app also offers a 12-week IBS low FODMAP program that provides users with personalized guidance and support in following the low FODMAP diet.
It is a CE-marked class I medical device within the European Union.
Connected devices and their apps in Quebec
Below are examples of connected devices and their apps reimbursed by the RAMQ (Régie de l'assurance maladie du Québec) based on certain criteria.
The FreeStyle Libre 2 system consists of a connected sensor that is applied to the skin and an app allowing viewing of the user's blood glucose values. The bundled app allows setting and receiving alarms while sleeping, for example, and glucose readings without needing fingersticks. The app also provides a detailed report of the glucose history and insights to help better understand the glycemic patterns.
It is a certified medical device Class III by Health Canada, Class II by the FDA and Class CE IIb by the European Union.
The company has obtained partial or full coverage of the FreeStyle Libre system in 36 countries, including Canada, France, Germany, Japan, the UK and the USA. For Canada, the FreeStyle Libre 2 is publicly covered in Quebec, Ontario, Saskatchewan, Manitoba and PEI.
In Quebec, the reimbursement criteria for the FreeStyle Libre 2 are:
People living with type 1 diabetes aged 4 years and older.
People 18 years of age or older who inject insulin three or more times per day and who have had frequent episodes of hypoglycemia in the past year, despite compliance with a glycemia management plan.
Individuals already being reimbursed for FreeStyle Libre by RAMQ (they do not need to take any further steps, as they are automatically reimbursed for FreeStyle Libre 2).
The Dexcom G6 is a continuous glucose monitoring (CGM) system similar to the FreeStyle system described above. The Clarity app connects to the system and provides relevant insights into users' retrospective glucose values, patterns, and trends.
The Dexcom G6 is a certified medical device Class III by Health Canada, Class II by the FDA and Class IIb by the European Union.
It is publicly covered in Quebec, Ontario, Alberta, British Columbia, Saskatchewan, Manitoba and PEI.
In Quebec, the reimbursement criteria for the Dexcom G6 are:
Person living with type 1 diabetes, 2 years of age and over, with at least one of these:
non-attainment of patient-specific glycated hemoglobin (HbA1c) value, despite optimal management of the disease
frequent episodes of hypoglycemia in the last year, despite compliance with a glycemia management plan
inability to recognize or signal hypoglycemia symptoms
One app reimbursed in Ontario
The COVID-19 pandemic has had some benefits, and one of them is that the Ontario government offered some free mental health support. In 2020, the app MindBeacon, an online therapy service, was made available free of charge throughout Ontario.
The MindBeacon app helps people with stress and anxiety by teaching them how to change their negative thoughts. It's a digital therapy platform that guides individuals through a personalized course of cognitive behavioural therapy. Users undergo online therapy with a licensed health professional who guides them individually to help them develop coping and resiliency skills.
Because the online meetings are considered human-led psychological therapies, their cost is partially or entirely reimbursed by many private insurers.
Are you covered?
Studies are numerous on the subject: some apps have proven benefits for the health of their users. It is, therefore, understandable that some public health insurance plans around the world are starting to reimburse the use of certain apps or are planning to do so in the near future. However, in Quebec and Canada, there do not seem to be short-term plans to consider such reimbursement by the public system.
In the meantime, some private insurances cover the use of some apps; the apps and the conditions are variable, so it is better to contact the insurance provider to inquire beforehand.
Finally, if you don't have access to private insurance, you can always look for the app that suits you on AppGuide.ca; the cost of the app is mentioned on each app report. You'll find that many apps are free or offer a range of free features or features you can try out before buying. The clinical robustness score also lets you know if the app has been proven effective by one or more studies if it was designed by a clinician, if an independent organization recommends it or if a regulatory organization licenses it. Other aspects presented in these reports, such as security and privacy, might also be important priorities for you. AppGuide will help you choose where to invest your money should you need to cover the cost yourself.
References
Kim Dekker, Jeroen S Benjamins, Teodora Maksimovic, Marco Filardi, Winni F Hofman, Annemieke van Straten, Eus J W Van Someren, Psychotherapy and psychosomatics, 2020, Combined Internet-Based Cognitive-Behavioral and Chronobiological Intervention for Insomnia: A Randomized Controlled Trial, https://pubmed.ncbi.nlm.nih.gov/31639813/
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