Medicare to Cover Diabetes Prevention Program

  • 24 Jan 2017

Diabetes is a costly disease and its prevalence is projected to increase approximately two fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. Fortunately, type 2 diabetes is typically preventable with appropriate lifestyle changes.

In 2018, Medicare will cover the healthy lifestyle program, known as the National Diabetes Prevention Program for your patients!  

Medicare has determined that the healthy lifestyle program, known as the National Diabetes Prevention Program (National DPP), can reduce the Medicare net spending and improve the quality of patient care. (The National DPP has been shown to reduce the incidence of diabetes by 58%). The rule establishing the Medicare Diabetes Prevention Program (MDPP) expansion was finalized in the 2017 Calendar Year Medicare Physician Fee Schedule. Future rulemaking is required to finalize the remaining policies of the MDPP expansion.

What is the National Diabetes Prevention Program?

The National DPP is a year-long healthy lifestyle program that teaches participants to make lasting lifestyle changes, like eating healthier and adding physical activity into their daily routine. Sessions are facilitated by a trained lifestyle coach who follows a curriculum approved by the Centers for Disease Control and Prevention.  The program supports participants to lose 5-7% of their body weight.

The program is for adults who:

  • are overweight (body mass index ≥24; ≥22 if Asian), 
  • have no previous diagnosis of type 1 or type 2 diabetes,

and have a blood test in the prediabetic range or a history of  gestational diabetes.

Referring patients to the National Diabetes Prevention Program is a recommended practice.
Based on strong evidence of effectiveness in reducing new-onset diabetes for people at increased risk of type 2 diabetes, the Community Preventive Services Task Force, an independent, non-federal panel of public health and prevention experts, recommends combined diet and physical activity promotion programs-like the CDC-recognized National  DPP.  

Your patients listen to you. 

Research shows that patients are more likely to engage in preventive health behaviors when their healthcare professional recommends them. DPP is delivered in a number of settings; including healthcare clinics, community-based organizations, and worksites. To learn more about referring your patients to the Diabetes Prevention Program, or becoming a CDC-recognized provider of the National DPP, please contact DOH.Community@health.ri.gov.