Since May 2020, reimbursement can be requested for Digital healthcare applications (DIGAs) in Germany. The prerequisite for reimbursement is a listing in the Federal Institute for Drugs and Medical Devices (BfArM) DiGA-directory, granted after successful completion of an assessment process. In June 2021, IQVIA first evaluated the BfArM’s decision-making and identified criteria that may positively impact a directory listing. In November 2021, the research was updated to consider the latest developments.

Published information for each app in the DiGA-directory was qualitatively compared according to pre-specified criteria by two independent reviewers. With no data available for denied apps, only DiGAs with permanent or preliminary listings were compared.

By 26 November 2021, twenty-four apps had received a positive assessment. Permanently listed apps (n=6) focused on health status improvements and/or patients’ health competency. None claimed to improve patients’ quality of life. Results from at least one randomized controlled trial (RCT) showed efficacy with medium or strong significant effect sizes (Cohen’s d > 0.4) versus standard of care (SOC). For preliminarily listed DiGAs (n=18), final results of positive care effects were not yet provided, but applications included study designs for RCTs including definitions of primary endpoints. The BfArM accepted the trial designs to be suitable to measure an app’s positive effects on health care within twelve months after listing. Since the last analysis, no preliminarily listed apps have been granted permanent DiGA-status. Evaluation periods were extended by up to five months for three apps. With none of the trials for preliminary apps being completed, possibilities for assessment remain limited. Claims for either medical benefit and/or patient-relevant structural/procedural improvements do not seem to impact the type of listing.

Updated research confirmed previous findings. For a DiGA-directory listing DiGA, the (planned) provision of RCT data seems to be gold standard. Medium to strong effects on the improvement of health status compared to SOC appear to be important for a permanent listing. Evaluation periods of five preliminarily listed apps are expected to be completed in December 2021, allowing for further analyses in the future.