DiGA apps on prescription: tips on billing and prescribing for doctors

Digital health applications, also known as DiGA apps, have been available in Germany since their official approval in 2019. Despite this availability, awareness of them among the population is still limited. Germany was the first country in the world to introduce digital medical applications, which seems surprising given the rather hesitant digital development in the German bureaucracy. But what exactly is behind the term DiGA app, what advantages do they offer doctors and patients and how are they correctly prescribed and billed? We explain.

What are DiGA Apps?

DiGA stands for Digital Health Application and is prescribed by a doctor. This is an application in the form of an app or a web application that patients can use conveniently on their smartphone, tablet or laptop. This application serves a variety of purposes, such as monitoring symptoms or reminding patients to take their medication regularly.

The legal basis for the DiGA app is the Digital Healthcare Act (DVG). This gives patients the right to use the DiGA app and to have the costs covered by health insurance companies. However, this is only the case if it has been officially tested by the Federal Institute for Drugs and Medical Devices (BfArM) and is listed in the directory for DiGA apps.

This distinguishes the officially approved digital health applications from conventional health apps, fitness trackers and similar applications. The latter have not been tested by the BfArM and are freely accessible to everyone in the App Store.

On which platforms are DiGA apps available?

DiGA apps are available for download for Apple iOS in the Apple App Store. DiGAs for Android can be downloaded from the Google Play Store. Web applications, which are browser-based, are activated directly on a website. To activate each DiGA, the health insurance company's activation code is required.

DiGA apps can help with these diseases

Digital health applications are used for a variety of conditions, including tinnitus, depression and diabetes. One example of this is the option for diabetics to transfer the data they have recorded using their blood glucose meter and insulin pens directly to a DiGA app such as Esysta.

Patients can then easily share this data with their doctor if required. This makes time-consuming manual entries in notebooks a thing of the past.

DiGA directory: Finding the right app for your patients

As DiGA apps are subject to government testing, there is an official directory in which all apps of this type are listed. As can be seen in the screenshot on the left, the applications can be filtered according to different areas of use:

The applications are labeled either "provisionally accepted" or "permanently accepted". In the case of the "provisionally accepted" designation, the positive impact of the app on the patient's health still needs to be proven. After this designation, the provider has a period of 12 to a maximum of 24 months to collect valid data and confirm the positive effect of the app.

If, on the other hand, the app is already marked as "Permanently included," the manufacturer has already proven that its app has a positive impact on the patient's health.

Costs for DiGA apps

The price of a DiGA app averages around 400 euros per quarter, according to an evaluation by the German National Association of Health Insurance Funds. Currently, around 30 apps are officially approved, costing from around 120 to almost 750 euros for three months. The statutory health insurers feel that this price level is too high in some cases and that the cost structure is too opaque. This is because they have to pre-finance the apps for up to two years - even if it later turns out that the app does not have a significant positive effect on the patient.

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How to prescribe DiGA apps on prescription

If you, as a physician, consider the use of a Digital Health App to be useful for a patient, you can prescribe the app using prescription form sample 16, which you normally use for drugs and medical aids.

Here you fill out the usual formalities and enter the Pharma Central Number (PZN) of the respective app. You can find the PZN in the DiGA app directory under "Information for healthcare professionals":

If you scroll down a little further on this page, you will find the number under the item "Regulation" in a box highlighted in color:

Please note: If different application durations are available, individual PZNs (pharmaceutical central numbers) can also be assigned for each!

Once your patient has received the completed prescription, they contact their health insurance company. The insurance company checks the prescription and then creates a specific prescription code. Your patient can then use this code to download the digital health application from the App Store.

Billing for digital health applications

Once you have prescribed the appropriate DiGA app for your patient, the only thing left to do is the billing. The reimbursement for the first prescription of a DiGA was limited until December 31, 2022. From this date, GOP 01470 and flat rate 86701 can no longer be billed separately. The remuneration reflected the special requirements of medical prescribing in the introductory phase of the DiGA as a new form of care.

From January 1, 2023, the issuing of an initial prescription for a DiGA has been integrated into Appendix 1 of the EBM and is thus a component of the insured and basic flat rates as well as other services of the EBM.

The personal designations used in this article always refer equally to all persons. For the sake of better readability, we have refrained from using double or opposite names.