Expanding Diabetes Care Services
General Description, Overview, and Opportunity
Unrealized opportunities exist for community pharmacists to impact margins by expanding diabetes care services, beyond testing supplies, offering stakeholders a win-win-win: healthier patients; lower costs for health care payers; and a new revenue source for independent community pharmacists facing declining prescription drug reimbursement. People with diabetes are dealing with the multiple co-morbidities and spend the highest dollar amounts in your pharmacy. Improving your margins is NOT a function of the number of test strips sold but rather the number of prescriptions filled. Most independent community pharmacies offer their patients diabetes testing supplies (DTS) and while insurance company payments for DTS have decreased significantly, progressive pharmacists aggressively market to secure persons with diabetes by providing ancillary services such as diabetes self-management education/training (DSME/T) programs and therapeutic diabetic shoes and inserts. Also, given the number of people living with prediabetes, community pharmacists are in an ideal position to increase recruitment and enrollment into the National DPP Lifestyle Change Program, particularly for under served populations.
Medicare Part B provides coverage of DSME/T services for beneficiaries who have been recently diagnosed with diabetes, or were determined to be at risk for complications from diabetes. Pharmacies must first obtain facility accreditation to provide DSME/T. In coordination with the American Association of Diabetes Educators (AADE), NCPA provides a DSME/T prerequisite education program entitled, "Diabetes Accreditation Standards-Practical Applications" (DASPA). Completing DASPA, meets all education requirements necessary to apply for AADE facility accreditation to become recognized as a certified program provider. Approved certified program instructors may include registered nurses, registered dietitians, or registered pharmacists.
A qualified DSMT/E program includes the following services:
Instruction in self-monitoring of blood glucose,
Education about diet and exercise,
An insulin treatment plan developed specifically for insulin-dependent beneficiaries
Motivation for beneficiaries to use the skills for self-management.
To address diabetes lower extremity challenges, Medicare Part B covers the furnishing and fitting of either one pair of custom-molded shoes and inserts or one pair of extra-depth shoes each calendar year. Medicare Part B also covers 2 additional pairs of inserts each calendar year for custom-molded shoes and 3 pairs of inserts each calendar year for extra-depth shoes. Medicare Part B will cover shoe modifications instead of inserts.
A doctor must certify that the beneficiary needs therapeutic shoes or inserts. A podiatrist or other qualified doctor must prescribe these items and they must be provided by one these:
Other qualified individual (under law, pharmacists are identified as an "other qualified individual" thereby recognized federally as being able to provide therapeutic shoes and inserts.
It should be noted that, individual States, may require additional personal credentialing beyond federal mandates to prescribe custom or non-custom therapeutic shoes. Personal credentialing may be obtained from the American Board for Certification in Orthotics, Prosthetics & Pedorthics or the Board of Certification/Accreditation.
As a payer, Medicare Part B has taken the lead in recognizing the role pharmacists can play in keeping beneficiaries with diabetes well and in their communities. Providing diabetes care services that complement the sale of prescriptions and DTS improve margins and provide significant value to the patient, making them likely to be a loyal pharmacy patron.
From Prevention to Pump Training: Opportunities in Diabetes Care
This program walks through more than a handful of services pharmacists can offer including wellness coaching, pump training and instructions for how to market and bill for services.
National Diabetes Prevention Program