Advancing The Profession of Pharmacy

The National Diabetes Prevention Program and the Consultant Pharmacist

by | Aug 30, 2018 | Consulting Pharmacist Education

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Opportunity for Consultants: National Diabetes Prevention Program

While this program has been around for many years, it has only been since 2016 that these programs have been billable under Medicare.

So, what is a diabetes prevention program?

Simply, it is a lifestyle change program intended to prevent or delay the onset of type 2 diabetes.

While there are many lifestyle change programs available in many communities, the ones that are eligible for reimbursement under Medicare are ones that are recognized by the Centers for Disease Control and Prevention (CDC).

Code: G code, G9873 – 9885

So what do you need to know: National Diabetes Prevention Programs can be offered by any individual or organization as long as they meet criteria to become a CDC recognized provider.

CDC criteria include the following:

  • Use of a CDC approved curriculum
  • Lifestyle coach training
    • 12 hours via a CDC approved curriculum (online or in person, cost ~$500 – $1000)​
  • Program must be at least 1 year in duration (can be up to 2 years) with at least 16 sessions in the first 6 months and 6 sessions in the last 6 months.
    • ​Sessions typically are done in group settings, but can be in-person, online, through distance learning, or a combination of the three

Ability to track participants progress (ex: physical activity, weight, etc.) which must be reported to the CDC to maintain recognition status.

How can you take advantage of this opportunity?

Because these codes do not have to be linked to a specific type of organization or healthcare provider, you can use these codes in a variety of settings as long as the patient meets eligibility criteria.

You could contract with a provider to offer these services to a groups of patients on a rolling basis. In a retail setting, you could offer group classes. As a pharmapreneur you can start a class in your community or develop online content for your audience.

Really, with this one, the sky is the limit as long as you can meet the CDC criteria and track outcomes.

Another huge benefit of this is that the enrollment is a minimum of 1 year, which allows you to track and monitor your patient outcomes long term.

The next opportunity we’ll discuss is remote patient monitoring.

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About the Author

Blair Thielemier, PharmD, is an MTM consultant pharmacist specializing in pharmacy billing models. She consults on and produces e-learning programs for state and national organizations, pharmacy wholesalers, payers, technology start-ups. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at PharmapreneurAcademy.com. She speaks internationally about trends in leveraging pharmacists to improve value-based care.

 

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