(1078) Sustaining Diabetes-related Services in Pharmacy Settings: How Pharmacy and Public Health Partnerships Make a Difference

Objectives: In 2018, the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation (DDT) initiated a five-year funding opportunity with public health departments in each state and the District of Columbia. The funding recipients (51) pursued activities that strengthened diabetes management and type 2 diabetes prevention interventions within their jurisdictions. One diabetes management intervention most recipients pursued was diabetes self-management education and support (DSMES), a service that facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist persons with diabetes in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The required diabetes prevention intervention was CDC’s National Diabetes Prevention Program (National DPP) lifestyle change program (LCP), a 1-year program which provides coaching to help participants improve health outcomes and lower their risk of type 2 diabetes. An option to involve the pharmacy sector in these diabetes-related interventions was available.
This research aims to understand significant barriers to this work and outline resources developed to address them.

Methods: Data were analyzed qualitatively and derived from two sources. The first involved a review of annual work plans and progress reports submitted to CDC by recipients during the first four years of the funding cycle. Descriptions of work conducted in partnership with pharmacies, pharmacists, or pharmacy organizations were flagged for review and analysis.
The secondary data source involved findings from a pharmacy reimbursement landscape analysis, which was also conducted during the funding cycle. Data were collected from research on pharmacy billing and reimbursement practices to identify gaps in publicly available information. The landscape analysis also reflected information gleaned from subject matter expert interviews with state health departments, national pharmacy associations, and practicing pharmacists with experience delivering the National DPP LCP and DSMES services.

Results: Of the 51 public health recipients, 94% collaborated with pharmacy partners within their jurisdictions. Activities were developed and carried out in ways that utilized the workforce to support public health diabetes initiatives, such as the development and delivery of DSMES and National DPP LCP in pharmacies, promotion of medication management relationships, provision of diabetes-related training for the pharmacy workforce, and support for reimbursement/billing and sustainability efforts for pharmacy-based diabetes services. Fifty-one percent (26) of state and pharmacy partners participated in billing activities. Specifically, 56% of pharmacies offering DSMES engaged in billing activities with their state health departments, and 60% of pharmacies offering the National DPP LCP engaged in billing activities.
This information was supplemented with key findings from the landscape analysis, which noted a lack of 1) national standards around pharmacists’ scope of practice and reimbursement capabilities, 2) standardized billing processes across systems and settings of care, and 3) comprehensive resources to guide pharmacies on billing and reimbursement for diabetes interventions.
The collation of these findings led to a call for information to inform a national level review of billing and reimbursement practices for pharmacy-based organizations delivering DSMES and the National DPP LCP.

Conclusions: The results of this research and the identified barriers resulted in CDC’s DDT leading an effort to create two resources, the National DPP Pharmacy Billing Playbook and DSMES Pharmacy Billing Playbook, designed to guide pharmacies through the Medicare billing process. Future application of these materials may allow for improved sustainability amongst pharmacies offering these diabetes interventions and may ease reimbursement concerns among pharmacies considering implementing such programs.