A Gambling Addiction Startup Just Did What No Fentanyl App Ever Managed: Get a State to Pay For It

Gambling disorder gets almost none of the infrastructure fentanyl and alcohol get — no SAMHSA hotline on primetime television, no naloxone equivalent, often no coverage line on a standard insurance plan at all — despite running the same neural reward pathways and the same family devastation as any substance use disorder. That’s what makes Birches Health’s April 2026 contract with Pennsylvania’s Department of Drug and Alcohol Programs worth watching past its own press release: a state agency is now paying directly for telehealth gambling treatment, statewide, insurance-covered or state-funded depending on who walks in the door.

A digital behavioral health startup just got a state government to fund treatment for a disorder most insurance plans still won’t touch — and that funding model, not the app itself, is the interesting part.

Founded in 2023, Birches has built what it calls the largest U.S. clinical network dedicated specifically to gambling disorder — individual and group therapy, peer support, and financial wellness coaching delivered virtually, in all 50 states. It raised $20 million across two rounds and landed on the 2026 NY Digital Health 100 list this summer, but the Pennsylvania deal matters more than either milestone, because it’s a state department of drug and alcohol programs — the same kind of agency that funds opioid treatment and syringe services — choosing to fund a behavioral, not chemical, addiction through the identical public-health channel.

That’s the model worth naming out loud for anyone building in this space: Pear Therapeutics, the FDA-cleared digital therapeutic for substance use disorder, went bankrupt in 2023 for the opposite reason — it needed insurance reimbursement to survive and couldn’t secure it fast enough, on a product that required a prescription and a single payer relationship to work at all. Birches isn’t waiting on a single insurer’s coverage policy; it’s stacking state contracts, insurance billing, and family-pay access simultaneously, so no one funding source getting cold feet takes the whole company down with it. Whether that model scales past Pennsylvania is the open question, and it’s one worth revisiting the next time a state’s opioid settlement dollars go looking for a home — process addictions are competing for the same public money now, and a state agency writing this kind of check for gambling disorder is a signal the money can move faster than the stigma usually allows.