Take this app twice a day, with water…

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Can you imagine a future where your doctor writes a prescription for an iPhone app rather than pills? If your answer is no, then I can bet you haven’t heard about WellDoc.

It commercializes an mHealth app called BlueStar that helps patients with type 2 diabetes manage their condition. It is FDA-approved and can only be downloaded with a prescription. Sounds amazing, right?

Digital health is experiencing an explosion of funding these days. In 2016 alone, over $8 billion of VC funds were injected into startups tackling a wide range of issues in healthcare. Depending on what you read, the digital health landscape can be divided into six to eight broad categories. One category of interest to our clients is “digital intervention and disease management.” It includes all the products or solutions that help patients, HCPs, payers, or caregivers to manage chronic conditions and intervene at the right time to prevent the patient from becoming high risk.

This category can further be divided into at least two sub-categories: medication augmentation and medication replacement. If you hear a biopharma company executive talk about their strategic focus on “beyond the pill” and/or “around the pill” solutions, it’s highly likely they are referring to these two categories. So what do they entail? Medication augmentation includes solutions that work in conjunction with medicines to improve patient outcomes. A few examples are Propeller Health, Omada Health, Proteus Digital Health, and WellDoc. Companies like AiCure— an AI-based technology that ensures adherence—also fall into this sub-category. The other category consists of companies like Big Health (Sleep.io), Virta Health, Woebot, and Kokobot, whose goal is to replace pills with scientifically designed apps to help patients manage various conditions.

Does this mean we are headed to a medicine-free future? I believe there are two factors that will determine the inroads that digital therapeutics make into care decisions:

  1. Disease state—there are some disease states that lend themselves more to digital therapeutics than a traditional approach. For example, mental health is a main area of focus for lots of digital therapeutics companies due to the complexity of the human brain and our lack of understanding of relevant biomarkers. That said, conditions like cancer might still require drugs. And in such states of prolonged/life threatening-disease states, I believe the role of digital technologies will shift upstream to revolutionize the drug discovery process.
  2. Regulatory approvals—in my previous blog post (read here), I highlighted FDA’s changing attitude towards digital therapies. I still believe this factor will be the key to determining their uptake. Doctors will still be gatekeepers to advise patients on which therapies will work compared to those that might not. And it’s more than likely they will lean towards the products that have gone through rigorous regulatory approval process. There is also an upside for companies to take the pain of going through this process. FDA approval can lead to more widespread adoption, which can then lead to quicker real-world evidence data and hence enable payer reimbursements.

Vijay Pande, one of the partners at Andreessen Horowitz, wrote the following on the company’s blog: “I’m confident that 10-20 years from now, when we look back on this phase of medicine, it’s going to seem backwards and even barbaric that our solution to everything was just giving out pills.”

Now that’s an interesting thought, right?

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