Akili’s FDA-approved ADHD video game EndeavorRx moved from prescription-only to over-the-counter in 2024 after filling just 20,000 prescriptions in three years. The prescription requirement, meant to signal credibility, instead created confusion and barriers that prevented families from accessing a clinically validated treatment.
The Prescription Barrier Problem
To understand why prescriptions failed EndeavorRx, consider every step a motivated parent had to take. First, they needed a doctor willing to prescribe it. Many pediatricians and psychiatrists had never heard of digital therapeutics, let alone felt comfortable recommending a video game as treatment. Physician education on these tools lags years behind traditional pharmaceutical adoption.
Even enthusiastic doctors hit walls. Insurance coverage was inconsistent at best, nonexistent at worst. Families couldn’t get a straight answer on what it would cost before committing to an appointment. The pricing uncertainty alone was enough to make parents hesitate.
Then came the truly absurd part: pharmacy fulfillment. EndeavorRx is software. It could be downloaded in minutes. Instead, families waited days for prescription processing. A system designed for physical pills applied to digital code. Every link in the chain added friction, and each point of friction gave families a reason to give up.
The Direct-to-Consumer Discovery
In October 2024, the FDA granted Akili authorization to market EndeavorRx over-the-counter for children ages 8-17 with inattentive or combined-type ADHD. CEO Matt Franklin called it “a game-changer for families managing ADHD, removing barriers to access.”
The shift wasn’t just regulatory. It was philosophical. Akili repositioned EndeavorRx from a clinical product families received to a tool families chose. When parents discover their child is struggling with attention and feel that urgent pull to help, the window of motivation is narrow. Direct availability means families can act in that moment, and consumer behavior research consistently shows that shortening the gap between decision and action dramatically improves follow-through for health interventions.
The OTC version includes built-in symptom screening, which elegantly addresses the concern that removing prescriptions means removing clinical oversight. Families get guidance without gatekeeping. Transparent pricing replaced insurance roulette, letting parents make clear cost-benefit decisions before committing.
