PursueCare, which bought some of Pear’s assets, is relaunching apps for treating substance use disorders
Mario Aguilar Aug. 22, 2024
Over a year after Pear Therapeutics filed for bankruptcy and shut down, its smartphone apps for people with substance use disorder and opioid use disorder are again available to patients.
After acquiring Pear’s Food and Drug Administration-cleared apps, called reSET and reSET-O, in December 2023, virtual addiction treatment company PursueCare this month began offering them to its patients. The company will use the apps to complement its care plans as it develops business opportunities around the treatments.
PursueCare’s approach to the relaunch reflects the growing pragmatism among companies hoping to bring prescription digital treatments for psychiatric and other conditions to market. As standalone offerings, these digital therapeutics have struggled to gain adoption by insurers, clinicians, and patients. Increasingly, companies are looking to use apps to support existing care and business models, rather than marketing them as standalone products.
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“There’s a lot of different ways where the new tools can be better integrated into the way that health care is delivered, and I think that’s what you’re seeing with this kind of solution,” said Marty Culjat, global head of digital medicine and regulatory innovation at consultancy Eversana. He added that it’s an advantage that PursueCare doesn’t need to rely on Pear’s treatments as the primary revenue source.
That’s a very different approach from the one embraced by Pear.
The company was a pioneer of FDA-cleared prescription apps for the treatment of psychiatric conditions, and its leaders had grand ambitions of growing it into a digital biotechnology giant with a range of treatments for different conditions that would be reimbursed like drugs. But the entirely new model took longer to pick up steam than the company anticipated. Despite some sales and a few deals to make its treatments available to patients in need, Pear ran out of money and filed for bankruptcy in 2023.
PursueCare CEO Nick Mercadante told STAT that the company wants to create a “self-sustaining model” whereby patients get access to the apps through the company’s virtual care business. He believes that digital therapeutics can eventually serve as a bigger piece of the company’s revenue, and in the long term, he hopes that insurers will pay for them as part of a comprehensive suite of treatment options.
“The best case scenario is being able to offer truly value-based care with all of our payer partners, where we can get patients the types of interventions that work best for them, and we think less about getting paid in individual services,” he said.
Even though Mercadante draws a stark contrast between the strategies of Pear and PursueCare, the companies are closely connected. PursueCare last year raised $20 million led by T.Rx capital, the venture firm run by former Pear CEO Corey McCann and Michael Langer, the son of biotech magnate Bob Langer. The Pear assets were acquired from an entity funded by T.Rx, and McCann sits on PursueCare’s board.
PursueCare is one of a crop of virtual care companies focused on substance use that have flourished since the pandemic, when the Drug Enforcement Agency temporarily lifted requirements that people be seen in person before receiving prescriptions for controlled substances, like those used for medication-assisted treatment for opioid use disorder, or MAT. PursueCare’s addiction treatment services, including therapy, counseling, and medication management, are currently covered by commercial insurance, Medicaid, and Medicare, and the company also operates a pharmacy that can supply the buprenorphine and naloxone drugs used for MAT. The flexibilities that allow this care to be delivered virtually are currently nearing expiration and may not be extended. Action from Congress and DEA would be necessary to extend them.
Research shows that patients feel very positively about virtual providers like PursueCare that offer an easier and friendlier alternative to the treatment status quo that can be complex, impersonal, and often feels punitive, said Ateev Mehrotra, a health policy professor at Brown University who studies telehealth use. He said that these services provide a promising opportunity to expand access to lifesaving care that many simply don’t get, but that the services haven’t conclusively proven that they deliver care on-par with in-person treatment. Mehrotra and his colleagues are studying this question right now.
Before Pear went bankrupt Mehrotra said he had explored studying the impact of reSET-O because he felt “having a clinical model where we use these kinds of digital tools to help support people and help them stay off illicit opioids and stay in treatment is a great option.” But he noted that providers he spoke with expressed skepticism about the clinical evidence backing up Pear’s apps and balked at the high prices the company wanted to charge.
About 1,000 PursueCare patients used one of Pear’s apps before the company went bankrupt and Mercadante unsurprisingly feels strongly that they can be beneficial to patients and can generate revenues for PursueCare. But in the short term, unlike Pear, the company’s plan doesn’t involve convincing insurers or a critical mass of providers to buy in.
PursueCare will offer appropriate patients a course of reSET or reSET- O for $90 out of pocket and will additionally seek reimbursement under remote therapeutic monitoring codes that allow providers to bill for supplying monitoring devices, including software, to patients and for tracking the progress of cognitive behavioral therapy treatment.
reSET is a 12-week course that delivers cognitive behavioral therapy that’s meant as an adjunct to outpatient treatment for substance use disorder. ReSET-O is similar but has medication tracking features and is meant as an adjunct to medication-assisted treatment. Both apps also employ a technique called contingency management that incentivizes users to stick to goals with rewards, and in clinical studies the apps have been shown to help keep people in treatment.
PursueCare is now rolling out the apps in six of the 11 states in which it operates: Kentucky, West Virginia, Pennsylvania, New Jersey, Maine, and New Hampshire. Mercadante says the company expects up to 50% of eligible patients will enroll. It has so far on-boarded over 100 patients and estimates it could get some 2,000 users from its initial launch.
PursueCare patients will be able to earn up to $75 in contingency management rewards per year for fulfilling different goals. Mercadante said the company wanted to offer more but needed to comply with regulations around inducing patients to use treatments. A large percentage of PursueCare’s users are on Medicaid and the company will offer it for free to people who cannot afford to pay, but they will receive only non-monetary in-app rewards for fulfilling goals.
By early next year, PursueCare will make app licenses available to other practices — these practices can in turn charge fees and bill for remote therapeutic monitoring.
PursueCare ultimately hopes that insurance will cover the initial purchase of the apps and contingency management. There, it will have to contend with many of the same problems encountered by Pear, including hesitance to cover new kinds of treatment and questions about the value of the apps in care. Mercadante has no illusions that health plans will pay over $1,000 as Pear had asked but he believes reimbursement in the hundreds of dollars is fair. In the long term, Mercadante hopes to be able to show strong evidence that PursueCare’s overall model is valuable, streamlining reimbursement tied to outcomes or other metrics.
Medicare, meanwhile, has floated a proposal whereby it would pay for digital mental health treatments like reSET and reSET-O. Mercadante said it’s always good to have more options, but that payment arrangement may not be more beneficial for PursueCare than the existing remote therapeutic monitoring codes. Still, it could open the door to broader reimbursement from commercial insurers.
Pear was able to land innovative agreements with Medicaid programs in Oklahoma, Florida, and Massachusetts, and PursueCare is working to rekindle some of those relationships.