Definition: The Medicare Diabetes Prevention Program (MDPP) is a program to help Medicare-insured individuals who have prediabetes delay or prevent T2D by focusing on lifestyle changes.¹ The MDPP was launched in February 2013 as a pilot program enrolling over 6,800 individuals at high risk for diabetes in the first year. Subsequent evaluation of participants showed reductions in inpatient hospitalizations and emergency department visits.² The MDPP is covered for eligible individuals through Medicare Part B who have a diagnosis of prediabetes, a BMI of 25 or more, and have never been diagnosed with T1D, T2D, or end-stage renal disease.¹
The MDPP is a 2-year program designed to assist individuals to eat healthier, be more active, and lose at least 5% of their total body weight.¹ Individuals may enter the program once in their lifetime and participate in 16 weekly sessions over the course of 6 months. This program is often a group setting with other enrolled members. The sessions are held weekly in a group-based classroom style setting or virtual distance learning setting.³ The MDPP sessions facilitate time for participants to discuss their progress throughout the program while sharing the adversities they are experiencing on their journey. The comprehensive services of the MDPP include tips for getting more exercise, weight management strategies, a trained coach to keep individuals motivated, and support from people with similar goals and challenges.⁴
Many pharmacists have advanced knowledge in diabetes prevention and management, allowing them to have a significant role through the MDPP. Pharmacist involvement provides greater access and more personalized care for patients, as well as relieves some burden from physicians. Some opportunities for pharmacists in the program include medication reconciliation, medication therapy management (MTM) including specific therapies for diabetes (i.e. statins and diabetes medications), nonpharmacological education, and weight management strategies.
How it relates to quality-based care: The MDPP gives patients the opportunity to significantly reduce their risk of T2D and associated complications and improve their health overall.⁵ This can promote a higher quality of care, improve institutional quality measures, and reduce health care costs.⁵ Specifically, MDPP supports quality-based care by improving hemoglobin A1C control, adherence to diabetes medications, and recommended screenings and examinations (eye, foot, dental, etc.). Through the work of the MDPP and pharmacist intervention, patients can be better informed about these outcomes and services. The number of patients progressing to uncontrolled diabetes is lowered, which ultimately avoids costly complications.
Involved organizations/oversight: The MDPP is a part of the CDC National Diabetes Prevention Program. The MDPP is administered and approved by programs that are in communication with CMS.⁶ Individuals in the MDPP may receive care from providers in hospitals, physician private practices, and clinics or through organizations such as community centers (YMCAs, Area Agencies on Aging, and local public health authorities) or faith-based organizations.⁴, ⁶ MDPP services provided by these facilities undergo an application process to register through CDC to become available to the community. MDPP coaches must be trained through CDC as well and are required to obtain an NPI, which is a unique identification number provided to health care workers.7
Resources:
1. CDC. Preventing Type 2 Diabetes with Medicare. CDC.gov. Available at: www.cdc.gov/diabetes-prevention/lifestyle-changeprogram/ndpp-medicare-program.html
2. Healthcare Transformation Task Force. Success of the Medicare Diabetes Prevention Program. Hcttf.org. Available at: https://hcttf.org/wp-content/uploads/2020/10/HCTTFAssessment_Success-of-the-Diabetes-Prevention-Program-.pdf
3. Noridian Medicare. Medicare Diabetes Prevention Program (MDPP). Med.noridianmedicare.com. Available at: https://med.noridianmedicare.com/web/jeb/topics/preventive-services/mdpp
4. Medicare. Medicare Diabetes Prevention Program. Medicare.gov. Available at: www.medicare.gov/coverage/medicare-diabetesprevention-program
5. National Association of Chronic Disease Directors. Medicare Diabetes Prevention Program (MDPP) Basics. Coveragetoolkit.org. Available at: https://coveragetoolkit.org/medicare/mdpp-basics/
6. National Association of Chronic Disease Directors. Medicare Diabetes Prevention Program: A Practical Guide for Medicare Advantage Plans. Coveragetoolkit.org. Available at: https://coveragetoolkit.org/wp-content/uploads/2024/04/Medicare-Diabetes-Prevention-Program_Guide-for-MA-plans.pdf
7. Centers for Medicare and Medicaid Services. MDPP enrollment tutorial. CMS.gov. Available at: www.cms.gov/files/document/mdpp-enrollment-tutorial-2024.pdf
Contributing authors:
Kailee Dickerson, PharmD candidate
Chapman University School of Pharmacy
Hindu Rao, PharmD, APh, BCACP
Clinical Assistant Professor of Pharmacy Practice
Chapman University School of Pharmacy
Follow-up question for members:
Has your clinic piloted pharmacist involvement in the Medicare Diabetes Prevention Program (i.e., through CDC-recognized National DPP pilots), where ambulatory care pharmacists supported patient follow up, lifestyle modification guidance, and/or medication management? If so, what has been most effective about the pharmacist’s involvement?