How You Can Sustain Your Program

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Pharmacists can improve the effectiveness of their lifestyle change programLCP and reduce costs for both the pharmacy and program participants by thinking strategically and maximizing the resources available. For example, using different various members of the pharmacy workforce to deliver the program can help manage costs and provide learning opportunities for staff. See the Pharmacy Workforce Call to Action sectionTable 4 on page 24 for more information.

Many state and public employee health plans, commercial health plans, self-insured employers, and state Medicaid agencies cover the cost of the National DPP LCP. The program is also covered by Medicare through the MDPP expanded model. Pharmacists can work with their patients to determine if they are eligible for coverage.

In March 2016, CMS certified the expansion of the National DPP into the Medicare program. This change was based on evidence from a model test sponsored by the CMS Innovation Center involving 5,969 Medicare beneficiaries who participated in the program through the YMCA of the USA.

The model test showed an average weight loss of 4.7% for participants who attended at least 4 sessions and 5.2% for those who attended at least 9 sessions. Participants also had fewer emergency department visits and inpatient hospitalizations, which reduced overall health spending. Medicare saved $2,650 per participant over 15 months.

CDC collaborated with the CMS Innovation Center on the model test, providing subject matter expertise, information from applied research studies, and data from the DPRP. MDPP services became available to eligible Medicare beneficiaries on April 1, 2018. About 23 million US adults with prediabetes are 65 or older and could benefit directly from this expansion.

For more information, see the MDPP Expanded Model website.

Health care worker speaking with elderly woman patient

How National Pharmacy Organizations Are Helping

National pharmacy organizations like the APhA Foundation and NCPA are working to increase the number of pharmacy-based organizations offering the National DPP LCP. Table 4 outlines current APhA and NCPA initiatives to support pharmacies.

Table 4. National Pharmacy Organization National DPP Initiatives
Project	Description
APhA Foundation’s Project Impact: Diabetes Prevention	The APhA Foundation’s Project Impact: Diabetes Prevention capitalizes on the strengths of each pharmacy partner to build infrastructure to improve delivery of the National DPP LCP. Pharmacists, pharmacy technicians, dietitians, and other health care professionals working in highly accessible pharmacy practice environments are trained to deliver the National DPP LCP to adults at risk of developing type 2 diabetes. The project uses a hybrid model that includes face-to-face classes, telehealth, and digital technology. This approach helps participants complete the LCP by tailoring classes to their individual needs. The extensive capabilities of the partnering organizations, as well as the use of community outreach and technology solutions, help support delivery of the multimodal program. The APhA Foundation’s current partners are The Kroger Co. and Tabula Rasa HealthCare. For more information about the APhA Foundation’s work with pharmacies, email your contact information and questions to info@aphafoundation.org.
NCPA-ADCES-OmniSYS National DPP Project	NCPA, in collaboration with the Association of Diabetes Care & Education Specialists (ADCES) and OmniSYS, launched a CDC-funded initiative to lower costs for pharmacies interested in obtaining CDC recognition and offering the National DPP LCP to their patients. Starting in 2020, NCPA recruited over 40 pharmacies to participate in the initiative. NCPA has since identified several key characteristics that have helped pharmacies effectively implement the program: Previous experience offering diabetes education or management services. Being located in a medically underserved area. Sufficient number of staff dedicated to the project, especially pharmacy technicians. Currently offering five or more clinical services. For more information about NCPA’s support for pharmacies delivering the National DPP LCP, go to its Want to start a Diabetes Prevention Program at your pharmacy? website.
DPRP Community Pharmacy Program	In spring 2022, the APhA Foundation partnered with NCPA to pilot the DPRP Community Pharmacy Program, which identifies high-performing, CDC-recognized community pharmacies that are already providing the National DPP LCP. The program then provides funding to help patients without health insurance enroll in the National DPP LCP and technical assistance to help pharmacies deliver the LCP. NCPA recruited five pharmacies, most of which had stopped providing in-person classes because of the COVID-19 pandemic. Support from the APhA Foundation and NCPA helped the pharmacies resume in-person classes. The APhA Foundation also gives pharmacies access to an easy-to-use scheduling, documentation, and reporting platform, as well as assistance with the required DPRP reporting for CDC recognition.

The Pharmacy Workforce Call to Action

The entire pharmacy workforce—including pharmacists and pharmacy technicians, residents, and students—can get involved in supporting the National DPP’s mission to prevent type 2 diabetes. This section describes specific actions that members of the pharmacy team can take to help expand the reach of the National DPP LCP. Table 5 shows team members best positioned for each role.

Table 5. How the Pharmacy Workforce Can Support the National DPP

How the Pharmacy Workforce Can Support the National DPP
Workforce Category	Tier 1: Promote Awareness of Prediabetes and the National DPP Among Patients at Risk	Tier 2: Screen, Test, Refer, and Enroll Patients	Tier 3: Offer the National DPP Lifestyle Change Program
Pharmacists	Almost always best positioned for this role	Almost always best positioned for this role	Often best positioned for this role
Technicians	Almost always best positioned for this role	Almost always best positioned for this role	Almost always best positioned for this role
Residents	Almost always best positioned for this role	Almost always best positioned for this role	Often best positioned for this role
Students	Almost always best positioned for this role	Often best positioned for this role	Sometimes best positioned for this role

Learn about how each member of the pharmacy workforce can support the National DPP in each of the three tiers.

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Educate patients about prediabetes: Pharmacists have the knowledge to effectively communicate information on prediabetes risk to their patients. They can also use their understanding of a patient’s medical history to customize this information. They are well positioned to educate both their patients and other pharmacy staff about prediabetes and the National DPP LCP. Pharmacists can also receive referrals from local health care systems and providers of the National DPP LCP.
Connect with peers and others outside of the health care system: Pharmacists are well connected beyond the health care system and can use these connections as an opportunity to share information about prediabetes and the National DPP LCP. They can also help raise awareness within their peer network by sharing information at conferences or by email.
Establish relationships with local organizations: Pharmacists can build relationships with local CDC- recognized organizations that offer the National DPP LCP. If applicable, they can ensure that local organizations know that the pharmacy will be referring patients to these programs. They can support local programs by distributing or displaying their promotional materials to raise awareness among patients. Pharmacists can also look for other ways to support the specific needs of local programs.

Tier 2. Screen, Test, Refer, and Enroll Patients

Include prediabetes screening, testing, referring, and enrolling as part of disease management counseling: Pharmacists provide disease management counseling for patients and can use this time as an opportunity to conduct prediabetes screening with the prediabetes risk test. If possible, pharmacists should administer blood glucose tests to patients who score high on the risk test. Patients who score high or who are found to have prediabetes should be referred to both a primary care provider for confirmatory blood glucose testing and to a CDC-recognized organization delivering the LCP in the community or online.

Tier 3. Offer the National DPP Lifestyle Change Program

Serve as a Lifestyle Coach: Recognized organizations are responsible for hiring, training, and supporting their Lifestyle Coaches. Lifestyle Coaches should be able to help participants make and sustain positive lifestyle changes. They should also have the understanding and sensitivity to help participants deal with a range of issues and challenges associated with making important lifestyle changes. Information on how to become a trained Lifestyle Coach is available on the National DPP Staffing and Training
Serve as a program coordinator: Program coordinators should be able to serve as both primary external champions of the program and organizational experts for program implementation consistent with DPRP Standards. They should supervise daily operations of the National DPP LCP and provide guidance and support for Lifestyle Coaches. They should understand DPRP data collection and submission requirements, including the importance of monitoring program data to ensure quality performance outcomes.

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Educate patients about prediabetes: Pharmacy technicians can help patients understand their risk of type 2 diabetes by educating them about prediabetes and sharing information about the National DPP LCP.
Establish relationships with local organizations: Technicians can build relationships with local CDC- recognized organizations that offer the National DPP LCP. If applicable, they can ensure that local organizations know that the pharmacy will be referring patients to these programs. They can support local programs by distributing or displaying their promotional materials to raise awareness among patients. Technicians can also look for other ways to support the specific needs of local programs.

Tier 2. Screen, Test, Refer, and Enroll Patients

Administer the prediabetes risk test: The risk test typically takes about 1 minute to complete. Technicians can use wait times at the pharmacy to distribute or administer paper versions.

Tier 3. Offer the National DPP Lifestyle Change Program

Serve as a Lifestyle Coach: Recognized organizations are responsible for hiring, training, and supporting their Lifestyle Coaches. Lifestyle Coaches should be able to help participants make and sustain positive lifestyle changes. They should also have the understanding and sensitivity to help participants deal with a range of issues and challenges associated with making important lifestyle changes. Information on how to become a trained Lifestyle Coach is available on the National DPP Staffing and Training
Serve as a program coordinator: Program coordinators should be able to serve as both primary external champions of the program and organizational experts for program implementation consistent with DPRP Standards. They should supervise daily operations of the National DPP LCP and provide guidance and support for Lifestyle Coaches. They should understand DPRP data collection and submission requirements, including the importance of monitoring program data to ensure quality performance outcomes.

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Educate patients about prediabetes: Pharmacy residents also have opportunities to educate patients about their risk of type 2 diabetes and share information about the National DPP LCP.
Establish relationships with local organizations: Residents can build relationships with local CDC-recognized organizations that offer the LCP. If applicable, they can ensure that local organizations know that the pharmacy will be referring patients to these programs. They can support local programs by distributing or displaying their promotional materials to raise awareness among patients. Residents can also look for other ways to support the specific needs of local programs.

Tier 2. Screen, Test, Refer, and Enroll Patients

Administer the prediabetes risk test or blood glucose test: The risk test typically takes about 1 minute to complete. Technicians can use wait times at the pharmacy to distribute or administer paper versions. If possible, they should administer blood glucose tests for patients who score high on the risk test. Patients who score high or who are found to have prediabetes should be referred to both a primary care provider for confirmatory blood glucose testing and to a CDC-recognized organization delivering the LCP in the community or online.

Tier 3. Offer the National DPP Lifestyle Change Program

Serve as a Lifestyle Coach: Group sessions of the National DPP LCP are led by trained Lifestyle Coaches, who can motivate and educate participants and significantly enrich their experience. Residents can serve in this role if their residency will extend over the course of the yearlong program. Having residents serve as Lifestyle Coaches can help keep program costs down and give residents additional professional growth opportunities. For example, involvement in the program could be tied to a residency project, particularly projects related to diabetes. Given the temporary nature of residency positions, pharmacies should take into account the cost associated with training. Information on how to become a trained Lifestyle Coach is available on the National DPP Staffing and Training
Serve as a program coordinator: Program coordinators should be able to serve as both primary external champions of the program and as organizational experts for program implementation consistent with DPRP Standards. They should supervise daily operations of the National DPP LCP and provide guidance and support for Lifestyle Coaches. They should understand DPRP data collection and submission requirements, including the importance of monitoring program data to ensure quality performance outcomes.

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Educate patients about prediabetes: Pharmacy students can provide general information on prediabetes and the National DPP LCP to patients.
Establish relationships with local organizations: Students can build relationships with local CDC- recognized organizations that deliver the National DPP LCP. If applicable, they can ensure that local organizations know that the pharmacy will be referring patients to these programs. They can support local programs by distributing or displaying their promotional materials to raise awareness among patients.

Tier 2. Screen, Test, Refer, and Enroll Patients

Administer the prediabetes risk test: The risk test typically takes about 1 minute to complete, and students can use wait times to distribute or administer paper versions. With training, students can provide follow-up recommendations for patients found to be at risk. Students can also refer patients to a CDC-recognized organization delivering the LCP in the community or online. Another way to involve students and provide additional learning opportunities is to encourage them to initiate and lead screening campaigns and projects.

Tier 3. Offer the National DPP Lifestyle Change Program

Support Lifestyle Coaches: Group sessions of the National DPP LCP are led by trained Lifestyle Coaches, who can motivate and educate participants and significantly enrich their experience. Students can support program delivery by helping Lifestyle Coaches—for example, by performing administrative tasks and coordinating program logistics.

How You Can Sustain Your Program

How National Pharmacy Organizations Are Helping

The Pharmacy Workforce Call to Action

Table 5. How the Pharmacy Workforce Can Support the National DPP

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Tier 2. Screen, Test, Refer, and Enroll Patients

Tier 3. Offer the National DPP Lifestyle Change Program

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Tier 2. Screen, Test, Refer, and Enroll Patients

Tier 3. Offer the National DPP Lifestyle Change Program

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Tier 2. Screen, Test, Refer, and Enroll Patients

Tier 3. Offer the National DPP Lifestyle Change Program

Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk

Tier 2. Screen, Test, Refer, and Enroll Patients

Tier 3. Offer the National DPP Lifestyle Change Program

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