New opportunities for community pharmacists to expand the diabetes care services that they provide offer a win-win-win: healthier patients; lower costs for health care payers; and a new revenue source for local pharmacists facing declining prescription drug reimbursement.
Most independent community pharmacies already offer their patients testing supplies and other diabetes equipment. Increasingly, some pharmacists are taking it a step further: Formally educating diabetes patients on how to manage their condition, officially known as diabetes self management education / training (DSME/T). Now, more and more health care payers are offering reimbursement for those services.
- The Department of Defense’s TRICARE program has released a final rule, which now allows for TRICARE reimbursement for DSMT services. However, the regulations do not specifically state that pharmacists are approved DSMT providers under TRICARE. So NCPA is asking the Pentagon for regulatory clarification that pharmacists may be eligible providers of DSMT services under the TRICARE program. We think they should follow Medicare’s lead and expressly approve pharmacists as DSMT providers, just as TRICARE did with regard to pharmacist-administered vaccinations.
- The Pittsburgh Business Group on Health (PBGH) has operated a pharmacist-driven diabetes management program called “LivingMyLife” since 2006 with independent and chain pharmacies. The program incentivizes diabetes patients among covered PBGH-members to work with a pharmacist trained to help them manage the disease through inducements like discounted or waived co-payments. This month, PBGH effectively declared the effort a success as evidenced by its decision, reported by the Pittsburgh Tribune-Review, to expand the program to cover heart disease and asthma treatments.
From reporter Thomas Olson’s account of the PBGH meeting: “There are about 24 million Americans with diabetes, and 36 percent of adults either are diabetics or will be because they are overweight, according to UnitedHealth Group. It said the average non-diabetic’s annual health care costs $2,800, and the pre-diabetic’s care is about $3,800. But the average diabetic’s health care costs about $24,000 a year. ‘It’s a massive problem in this country, and it could bankrupt us,’ UnitedHealth Executive Vice President Tom Beauregard told the gathering. It cost about $174 billion to treat American diabetics in 2007.”
To help community pharmacists get the proper training to get their facility accredited and become eligible for Medicare reimbursement for these services, NCPA partnered with the American Association of Diabetes Educators (AADE) to produce the Diabetes Accreditation Standards-Practical Applications (DASPA) program. A two-part online and in-person education program, the first live session was held in June. More than 90% of attendees found the program valuable and helped them meet their objectives to be able to apply for accreditation.
Community pharmacists’ next opportunity to participate in a live DASPA training program is Oct. 21-22 in conjunction with NCPA’s Annual Convention and Trade Exposition. See NCPA’s Website to learn more about the DASPA program.