Health Plans Should Cover Diabetes Prevention Programs, AMA Says

The American Medical Association (AMA) is calling for public and private health insurers to include the Centers for Disease Control and Prevention (CDC)’s National Diabetes Prevention Program as a covered benefit for beneficiaries at risk of developing type 2 diabetes. 

The organization adopted an official policy encouraging public and private health plans to cover the prevention program at its annual meeting in Chicago, IL (June 11-15, 2016).

“More than 86 million Americans are currently living with prediabetes, and nearly 90% of them are unaware they have it and are at high risk of developing type 2 diabetes. We have a proven way to help these people make necessary lifestyle changes that can help them avoid developing the disease, but health coverage for these programs is limited and varies by location and insurer,” said Andrew W Gurman, MD, incoming president of the association.

“We urge both private and public health care payors to offer the diabetes prevention program under their health plans to give more people access to these proven programs.”

The new policy aligns with ongoing efforts by the AMA to prevent type 2 diabetes. In recent years, the association’s efforts have focused on increasing awareness of prediabetes and encouraging physicians to screen at-risk patients and refer them to diabetes prevention programs recognized by the CDC.

Earlier this year, the AMA applauded an announcement by the US Department of Health and Human Services (HHS) to authorize Medicare coverage of the evidence-based National Diabetes Prevention Program for beneficiaries at high risk of developing type 2 diabetes. The association is encouraging HHS to move quickly with its plan to provide coverage under Medicare.

According to an AMA news release, the policy approved last month also encourages hospitals to offer the National Diabetes Prevention Program, either in-person or virtually and to allocate community benefit dollars to cover the cost of enrolling participants. The policy calls for the association to work with the American Hospital Association and other groups to develop and disperse guidance on using community benefit dollars to cover costs.

According to the AMA, up to a third of patients with prediabetes will go on to develop type 2 diabetes within 5 years if they do not lose weight through healthy eating habits and exercise.—Jolynn Tumolo