OBJECTIVES:

In 2022, payers and manufacturers concluded first price negotiations for permanent DiGAs. In March 2022, the German national association of payers (GKV-SV) published a first report on its perspective on DiGA’s costs and relevance in the German healthcare system. Purpose of IQVIA’s analysis was to evaluate DiGA price developments and discuss these in terms of payer positions.

METHODS:

IQVIA extracted all DiGA prices from DiGA-directory to track changes from manufacturer to negotiated prices. To identify payer perspectives on DiGA pricing, a qualitative content search was conducted in relevant German healthcare media from March to June 2022 using pre-specified search terms. Relevant quotes were identified by keyword searches in the extracted articles.

RESULTS:

By June 2022, there were 12 permanent and 19 preliminary DiGAs. Price negotiations were completed for 4 permanent DiGAs. Disagreements between manufacturers and GKV-SV required an arbitration board to set reimbursement prices in all 4 cases resulting in an average 54% reduction compared to previous manufacturer prices. For mental health DiGAs, relative costs seem to be 63% lower than standard care costs.

Besides the GKV-SV report, 20 relevant news articles on payer positions were identified with the majority of the extracted payer quotes being critical on DiGA pricing. Criticism focused on 8 topics most commonly addressing the evidence’s quality underlying pricing decisions, the high level of manufacturer prices, the discussion around add-on vs. replacement therapy, and the reimbursement option for preliminary DiGAs.

CONCLUSIONS:

Despite payers recognizing the innovative character of DiGAs, reimbursement price levels remain unjustified and too high in their opinion. In contrast, DiGAs seem to face significant price reductions after reimbursement negotiations with lower relative costs than standard care costs. Further analyses on the arbitration board’s rationale, role of selective contracts, future price negotiations as well as further stakeholder positions are required to confirm or reject current payer criticism.