Medicare, Medicaid would have to cover app-based prescription therapies

What does this do?

This bill requires Medicare and Medicaid to cover "prescription digital therapeutics" — FDA-cleared software, apps, or devices that prevent, manage, or treat medical conditions primarily through software. Starting January 1, 2026, these products become a covered Medicare benefit, and Medicaid must cover them too. The bill also sets timelines for Medicare to create payment methods and billing codes for these products.

Who does it affect?

Medicare and Medicaid patients who could be prescribed app-based or software-based treatments, and manufacturers of these digital therapeutics. Doctors and health systems are also affected, since this creates a new billable treatment category.

Why does it matter?

This establishes a formal, government-reimbursed pathway for software-based treatments, changing how doctors can prescribe and bill for care alongside traditional drugs and devices.

What does it cost, and who pays?

• annual reporting required from manufacturers
• fines up to $10,000 per day for false reports