Since 2017, the Diabetes Care Value Program has been dedicated to providing robust support for individuals managing diabetes and those at risk, focusing on improving health outcomes and mitigating the financial impact of diabetes for both patients and plan sponsors. In 2022, a significant expansion of the program introduced innovative tools and resources designed to enhance both the prevention and management of this complex, chronic condition.
The escalating diabetes epidemic remains a critical concern today, affecting over 38.4 million Americans. This widespread condition presents substantial challenges and costs for employers and plan sponsors alike. To effectively address this, holistic solutions that harness the power of the latest digital tools are essential. These solutions can cater to the unique needs of each patient, fostering better adherence to treatment plans and ultimately leading to improved health outcomes.
A cornerstone of the Diabetes Care Value program is the inclusion of continuous glucose monitors (CGMs) under pharmacy benefits coverage. This CGM integration offers unparalleled convenience and delivers vital clinical insights into a patient’s glucose levels. Fluctuations in blood sugar can cause both immediate and long-term health issues. When clinically appropriate, CGMs are instrumental in helping individuals achieve their health objectives while also contributing to a lower overall cost of care.
The Diabetes Care Value program strategically blends conventional pharmaceutical interventions with a suite of tools and resources from across Evernorth’s health services business. This comprehensive approach empowers patients to gain a deeper understanding of their diabetes and manage it more effectively. Beyond CGM coverage under pharmacy benefits, the enhanced program features several key components to facilitate and optimize adoption, including:
- Predictive analytics: Utilizing data-driven insights to proactively identify and engage eligible members and their healthcare providers. This proactive outreach supports informed decision-making regarding the potential benefits and effective utilization of CGM technology.
- SmartPA: Implementing a streamlined prior authorization process to ensure seamless access to necessary therapies for members who are prescribed CGMs, reducing administrative hurdles and delays.
- Specialized pharmacist support: Providing dedicated pharmacist expertise for members using CGMs. This support is crucial for successful initiation and sustained adherence to CGM therapy, ensuring optimal usage and outcomes.
Participating plans also gain access to significant financial benefits, including plan discounts on participating CGMs and discontinuation credits for selected preferred products within the program.
Beyond offering affordable diabetes treatments, the integration of tools like CGMs within the Diabetes Care Value program fosters a more holistic and proactive approach to diabetes management. By empowering both members and plan sponsors to take proactive steps, the program is effectively addressing this complex and costly disease.
Furthermore, recognizing the interconnected nature of chronic conditions, this comprehensive strategy extends its benefits across a range of related health challenges. For instance, in 2023, the Diabetes Care Value program, as an integral part of the value-based SafeGuardRx platform, played a key role in increasing statin therapy initiation by an additional 18.2% among enrolled patients at risk of heart disease and stroke. It is estimated that widespread adoption of similar statin utilization rates could prevent over 21,500 heart attacks in the next decade.
The Diabetes Care Value program further incorporates a preferred quality pharmacy network to drive down costs and enhance medication adherence. It also leverages the National Preferred Formulary and utilization management tools to ensure access to the most cost-effective diabetes medications. Additionally, the program offers reimbursement opportunities in cases of therapy discontinuation, and specialized support is available through the Diabetes Therapeutic Resource Center®.
Originally published on 8/31/22 and updated on 11/22/24.
