Germany built a reimbursement route for digital therapeutics. The lesson is about evidence, not code.

Germany's digital health applications pathway did something no other large system had attempted at scale. It created a route by which a software product could be prescribed and reimbursed, with provisional listing while evidence was gathered.

Several years of operation have produced the thing the field most needed, which is data about what happens when you actually pay for this category.

What worked

Manufacturers engaged. Products entered the system, prescriptions were written, and a body of real world usage exists that did not exist before. The provisional listing mechanism solved the chicken and egg problem where evidence requires funding and funding requires evidence.

What did not

Prescription volumes concentrated heavily in a small number of products and indications, notably mental health. Adherence after initial download was frequently poor, which is the oldest finding in digital health and remains the least solved. And some provisionally listed products failed to convert to permanent listing, which is the system working as designed but reads publicly as failure.

The transferable lessons

Set the evidence bar at the outcome the payer cares about, not at engagement. Require adherence reporting as a condition of listing. Price provisionally listed products below permanently listed ones. And publish the delisting decisions clearly, because a pathway that only announces admissions loses credibility.

For systems considering the same route

The pathway is worth copying. The specific price setting mechanism, which allowed manufacturers to set the first year price, is the part most observers would change.