Access to Prescription Digital Therapeutics Act of 2025

This bill would let Medicare and Medicaid cover certain “prescription digital therapeutics.” These are doctor‑prescribed software tools or apps, cleared or approved by the FDA, that help prevent, manage, or treat medical conditions. Medicare coverage would begin on or after January 1, 2026, and Medicaid programs would also cover these products .

Medicare must set up how to pay companies for these products within one year. Payments could be one-time or ongoing, and must consider list prices, typical payment rates, and whether the product needs continued use. Medicare must also create product-specific billing codes within two years. Starting January 1, 2026, manufacturers must report what private insurers paid, how much was distributed, and how many people used the product each year. There can be fines of up to $10,000 per day for failing to report or for false reports, and reported data must be kept confidential under existing rules.

• Who is affected: People on Medicare and Medicaid; companies that make prescription digital therapeutics.
• What changes: These products can be covered; Medicare sets payment rules and billing codes; manufacturers must report data and face fines if they do not .
• When: Medicare coverage starts on or after January 1, 2026; payment rules within 1 year; billing codes within 2 years; manufacturer reporting by January 1, 2026 .