HHS Announces Plan to Propose Medicare Coverage of Diabetes Prevention Program

On Wednesday March 23, 2016, the Department of Health and Human Services (HHS) announced a plan to propose Medicare coverage of the National Diabetes Prevention Program (DPP), a multi-session educational program designed to encourage participants to make lifestyle changes to improve their health and decrease their risk of type 2 diabetes.  This change will mark a historic step forward in the battle against type 2 diabetes in the United States, where roughly one in four individuals ages 65 and older are living with diabetes and more than half meet the criteria for prediabetes.

As the Center for Health Law and Policy Innovation (CHLPI) highlighted in its recent report, Beating Type 2 Diabetes: Recommendations for Federal Policy Reform, the DPP has shown great promise as a strategy for fighting type 2 diabetes, especially among seniors.  In a groundbreaking 2002 study, researchers found that participation in the DPP reduced the incidence of diabetes by 71% for individuals 60 years and older. Building upon that research, in 2011 the Centers for Medicare and Medicaid Services (CMS) awarded the YMCA more than $11.8 million to test the effectiveness of the DPP among certain Medicare beneficiaries.

In yesterday’s announcement, HHS released data highlighting the success of this demonstration. According to HHS, the Medicare beneficiaries in the program lost roughly 5% of their body weight, thereby reducing their risk of diabetes.  Additionally, the program resulted in healthcare savings of $2,650 per enrollee over a 15-month period.  Based upon these impressive results, HHS plans to use its authority under the Affordable Care Act to expand the demonstration to make the DPP broadly available across the Medicare program.

CHLPI applauds HHS for taking this innovative step to fight type 2 diabetes in the United States.  We encourage other public and private insurers to follow Medicare’s example in order to ensure that all Americans living with prediabetes have the chance to access the DPP and beat type 2 diabetes before it starts.