Picture a neurology appointment five years from now. You walk out with two things: a refill for your regular medication, and a prescription code for an app you download that afternoon. That’s not speculative fiction. It’s already happening in a handful of clinics, just not evenly, and not without a fair amount of financial wreckage along the way. The category is called prescription digital therapeutics, and 2025 was the year the pieces that make or break a medical product, clinical evidence and insurance reimbursement, finally started lining up at the same time. 🎮
The video game that started it all (and nearly died)
The first domino was EndeavorRx, a video game built on research from UCSF neuroscientist Adam Gazzaley, whose 2013 Nature paper found that older adults who played a driving-and-distraction game called Neuroracer for six weeks showed measurable gains in attention. Akili Interactive turned that finding into a kids’ version, and in June 2020 the FDA cleared it as the first video game treatment for pediatric ADHD. It felt like the opening chapter of something big.
Then reality showed up. Akili went public in 2022 at a valuation near $1 billion and proceeded to watch it collapse. The core problem wasn’t the science, it was that insurers simply wouldn’t pay for it. By 2024 the company had cut staff twice, abandoned its prescription-only model, and was acquired for just $34 million, a fraction of what it raised. It wasn’t alone. Pear Therapeutics, another early digital therapeutics darling, filed for bankruptcy the same year. Getting the FDA’s blessing turned out to be maybe a third of the battle. 📉
The neurological pipeline that’s actually working
Here’s where the story gets more interesting, and more specific to neurology rather than psychiatry. In April 2025, Click Therapeutics won FDA marketing authorization for CT-132, the first prescription digital therapeutic built specifically to prevent episodic migraine. Its pivotal trial, ReMMi-D, enrolled 558 patients already on standard migraine medications and showed the app meaningfully cut their monthly migraine days on top of whatever drugs they were already taking. That’s a real neurological indication, not attention or mood.
Stroke rehab is showing similar traction. MedRhythms built a device called InTandem that straps sensors to your shoes and plays music that speeds up as your walking cadence improves, essentially gamifying rhythmic auditory stimulation. It cleared the FDA in 2023, and a 2024 randomized trial of more than 80 stroke survivors, published in Nature Communications, found something that actually surprised skeptical clinicians. As physical therapy researcher Lou Awad’s team at Boston University put it, patients using InTandem had fewer falls than the control group, not more, even though they were walking faster. A few other things worth knowing about this current wave:
InTandem is already covered by some insurance plans, at a rental cost of roughly $1,800 a month
RelieVRx, a VR headset for chronic low back pain, and Stanza for fibromyalgia are both FDA-cleared and reimbursable
A February 2026 systematic review found AI-assisted and gamified platforms showing consistent benefit across stroke, Parkinson’s, spinal cord injury, and MS rehab, though the authors flagged real gaps in trial quality
None of these products are meant to replace medication. They’re adjuncts, and every credible one says so explicitly
Why insurance finally started paying attention
This is the part that actually explains the “next 5 years” in this headline. For most of the 2020s, a doctor could prescribe a cleared digital therapeutic and then watch the patient get billed directly because there was no code to submit to insurance for it. That changed fast. In November 2024, CMS approved three new reimbursement codes for digital mental health treatments, and in September 2025 Cigna became the first major commercial insurer to launch a formulary specifically for FDA-cleared digital therapeutics. CMS then expanded those codes again in November 2025 to include ADHD-specific tools, with the change taking effect in 2026.
Money follows codes, and codes follow evidence. The digital therapeutics market sat around $3.5 billion globally in 2025 and is projected to keep climbing at close to an 18% annual growth rate through the next decade. That’s not hype math, it’s the direct result of insurers finally having a billing mechanism that doesn’t require a one-off negotiation for every single product. Have you noticed your own doctor mentioning an app instead of a pill yet? I’d bet that’s coming sooner than you think. 👇
The catch: FDA cleared doesn’t mean proven
I want to be straight with you here, because this space has burned people before. An FDA clearance for a digital therapeutic is often a De Novo authorization, meaning it’s a genuinely new category of device rather than something proven equivalent to an existing one. That’s a real regulatory bar, but it’s not the same as the years of post-market data a drug typically accumulates. Some clinicians, including members of the American Academy of Pediatrics, have publicly pushed back on how quickly ADHD games in particular reached the market, arguing the studies were promising but still small relative to the population being treated.
There’s also a less glamorous obstacle: people simply stop using apps. Adherence drops off the way it does with any home exercise program, digital therapeutics companies call it app fatigue, and a device that works beautifully in a supervised trial can underperform once it’s unsupervised in someone’s living room. A few things I’d watch for as this space matures:
Whether real-world adherence data holds up to the numbers seen in controlled trials
Whether more insurers follow Cigna’s lead rather than treating each product as a special case
Whether products keep publishing in journals like Nature Communications instead of just press releases
Whether the field learns from Akili and Pear’s collapse instead of repeating it
We’ve covered the regulatory grind that makes this whole category so slow to build in 7 competitive advantages only neurotech companies can build, and if you’re curious what’s already sitting on shelves versus still in trials, our breakdown of 5 neurotech devices you can actually buy today is a good next stop. It sits alongside the same shift we described in how neurotech is quietly replacing antidepressants for some patients: pills aren’t going anywhere, but they’re no longer the only thing a neurologist can reach for.
So no, your neurologist probably won’t hand you a Nintendo Switch next visit. But the odds that they hand you an app instead of, or alongside, a prescription pad just got a lot better than they were two years ago. Would you actually use one if it were covered by your insurance?