What is happening:
In August 2021 the United States Preventive Services Task Force (USPSTF) recommended that adults, aged 35 to 70 years who are overweight or obese, be screened for prediabetes or type 2 diabetes. In addition to these screenings, USPSTF recommended that clinicians should offer patients with prediabetes effective preventive interventions. Preventive interventions include lifestyle modifications that focus on diet, physical activity, or both. They also include taking the medication metformin.
What’s the issue? In the U.S. it is estimated that 13% of adults have diabetes and up to 34.5% are considered to have prediabetes. In addition, diabetes is the leading cause of kidney failure and of new cases of blindness in adults. Screening asymptomatic adults and subsequently offering preventive interventions to individuals with prediabetes should ultimately improve health outcomes and reduce healthcare costs for plans, plan sponsors and individuals.
What do you need to know?
- The USPSTF recommendation is effective for plan years beginning on or after August 1, 2022. It requires plan sponsors to offer to individuals aged 35 to 70, who are obese or overweight with prediabetes, preventive interventions at no cost to members. Preventive interventions include lifestyle modifications that focus on diet, physical activity, or both. They also include taking the medication metformin.
- As with other ACA requirements, a plan sponsor may incorporate utilization management programs for these products.
What steps should you take?
Plan sponsors should work proactively with their Pharmacy Benefit Manager to assure your pharmacy benefit is set appropriately to assure compliance with this new recommendation.