Digital Cognitive Behavioral Therapy for Fibromyalgia to be Covered by Highmark Health

Highmark Health will provide insurance coverage for Swing Therapeutics’ Stanza, a digital therapeutic for the treatment of fibromyalgia symptoms, according to an announcement from Swing.1

“Behavioral therapies like Stanza are guideline-directed treatments for fibromyalgia, but until now, access has been limited for both patients and providers,” Mike Rosenbluth, CEO of Swing, said in a statement.1 “Highmark’s decision is a pivotal moment for people living with fibromyalgia, offering them the opportunity to incorporate effective, non-drug options into their care plan.”

Highmark will offer reimbursement for its commercial members across Pennsylvania, West Virginia, Delaware, and New York. Stanza is a smartphone-based, self-guided digital acceptance and commitment therapy (ACT), which is a form of cognitive behavioral therapy (CBT). It is available through Swing Care, a specialty clinic for comprehensive fibromyalgia treatment, which launched in Pennsylvania in 2024. Swing Care aims to provide patients with access to virtual care integrating non-pharmacological therapies, including behavioral care, sleep management, meaningful movement coaching, and peer support, with medication management.1

“At Swing Care, we’re committed to helping patients find real relief with a supportive, comprehensive approach to managing fibromyalgia that truly improves patients’ lives,” Andrea Chadwick, MD, MSc, Medical Director of Swing Care, added.1 “Incorporating innovative treatments like Stanza is a part of that transformation—and Highmark coverage puts it in reach for many more patients that could benefit.”

Stanza previously demonstrated efficacy in helping to manage fibromyalgia in adult patients when compared with digital symptom tracking in positive data from the phase 3 PROSPER-FM trial (NCT05243511) published in July 2024.2 Participants aged 22-75 years across 25 United States community sites were randomized to the digital ACT group or an active control group that offered daily symptom tracking and monitoring and access to health-related and fibromyalgia-related educational materials.

The trial screened 590 people and enrolled 275 (257 women and 18 men) between February 2022 and February 2023. Of the enrolled participants 140 were randomly assigned to the digital ACT group and 135 to the active control group. The investigators found that at 12 weeks, 99 (71%) ACT participants reported improvement on PGIC compared with 30 (22%) active control participants, a 48·4% proportional difference (95% CI, 37·9–58·9; P <.0001). Participants in the digital ACT group were also more likely to be “much improved” or “better” (between-group difference in proportions, 21%; P< .0001), and a much smaller proportion of participants in this group reported worsening on PGIC (5% vs 24%; P <.0001).2

“Despite the proven benefits, real-world access to CBT and ACT is limited by a scarcity of trained therapists, few treatment centers, referral barriers, low insurance reimbursement, and prohibitive costs… A self-guided digital ACT therapy can substantially improve accessibility and enable and promote convenient ACT treatment engagement for patients, potentially enhancing its efficacy and complementing the patient’s overall fibromyalgia management in partnership with their health-care provider,” lead investigator R. Michael Gendreau, MD, PhD, president, Gendreau Consulting, and chief medical officer, Virios Therapeutics, and colleagues wrote.2

REFERENCES

1. Highmark Covers New FDA-Cleared Treatment for Fibromyalgia Symptoms from Swing Therapeutics. News release. Highmark. February 4, 2025. https://www.biospace.com/press-releases/highmark-covers-new-fda-cleared-treatment-for-fibromyalgia-symptoms-from-swing-therapeutics

2. Gendreau RM, McCracken LM, Williams DA, et al. Self-guided digital behavioural therapy versus active control for fibromyalgia (PROSPER-FM): a phase 3, multicentre, randomised controlled trial. Lancet. 2024; 404(10450): 364-374. doi: 10.1016/S0140-6736(24)00909-7