Pharmacist Toolkit Tier 3: Offer the Lifestyle Change Program

How offering the program can benefit pharmacies

It's free to apply to offer the National DPP lifestyle change program. Once a pharmacy's application is accepted, it will receive pending recognition and be listed on the CDC website. It will become part of a nationwide community of organizations working to prevent type 2 diabetes among people at risk.

A growing number of employers and insurers, both public and private, are reimbursing participants for the National DPP lifestyle change program. Most insurers require CDC recognition and reimburse using a pay-for-performance model. In 2018, the program became available to eligible Medicare beneficiaries as a covered service.

The National DPP can provide learning and professional growth opportunities for the pharmacy workforce. Pharmacy staff members are well positioned to be Lifestyle Coaches because they're familiar with patient care and motivational interviewing techniques. The National Community Pharmacists Association (NCPA) can provide information and resources to help organizations deliver the National DPP lifestyle change program.

Steps to deliver the lifestyle change program

If your pharmacy decides to deliver the National DPP lifestyle change program, you'll need to submit an application to become a delivery organization. See details below about the Diabetes Prevention Recognition Program (DPRP) process.

Some schools of pharmacy are also working to expand access to and delivery of the National DPP lifestyle change program:

• The University of North Carolina's Eshelman School of Pharmacy embedded the National DPP into its curriculum. This prepares students for their clinical rotations, and helps increase prediabetes screening, testing, and referrals to local lifestyle change program classes.
• The Southwestern Oklahoma State University College of Pharmacy developed a course based on the National DPP lifestyle change program to train students as Lifestyle Coaches. The course also pairs fourth-year pharmacy students with organizations offering the National DPP to help people with limited resources in Oklahoma.
• The Wilkes University Nesbitt School of Pharmacy created an elective course for students to train as National DPP Lifestyle Coaches. The school then matched students with local, independent pharmacies to support and lead implementation of the lifestyle change program. Other students partnered with pharmacies across the state to support lifestyle change program classes.

DPRP process

Pre-application

• Read and understand the current DPRP Standards.
• Complete CDC's DPRP Organizational Capacity Assessment (strongly recommended).
• Address any capacity gaps identified by the assessment.
• Review other materials about the National DPP and the DPRP on the National DPP Customer Service Center.

Application submission

• Complete the online DPRP Application form.

Pending recognition

• Submit a completed application.
• Use a CDC-approved curriculum.
• Offer the 12-month lifestyle change program, which includes a minimum of 16 weekly sessions in months 1 to 6 followed by a minimum of 6 monthly sessions in months 7 to 12.
• Agree to start the first session within 6 months of the effective date.
• Agree to submit required participant data to the DPRP every 6 months.

Organizations can stay at this level indefinitely if they submit the required data every 6 months. At any evaluation period after the first 12 months, they can move to preliminary recognition if they meet DPRP Standards requirement 5 or to full recognition if they meet requirements 5 through 7.

Preliminary recognition

• Submit required data every 6 months.
• Meet requirements for pending recognition.
• Meet requirement 5: Organizations must retain at least 5 completers in the evaluation cohort (eligible participants who attended at least 8 sessions in months 1 to 6 and whose time from the first session to the last session is at least 9 months).

Organizations can stay at this level indefinitely if they submit data every 6 months and meet the requirements for preliminary recognition within 3 years of first achieving it and at least every 3 years thereafter. At any evaluation period, they can move to full recognition if they meet DPRP Standards requirements 5 through 7.

Temporary preliminary recognition

• Achieve preliminary or full recognition for at least one delivery mode (in person or online).
• Submit a completed application for an additional delivery mode.

Existing organizations with preliminary or full recognition can obtain a new org code (for a new delivery mode) at the temporary preliminary level rather than starting over at pending recognition. However, the organization is responsible for meeting the requirements for preliminary recognition for the new delivery mode from that point forward.

Full recognition

In order to have full recognition you must:

• Submit required data every 6 months.
• Meet the requirements for pending recognition.
• Meet the requirements for preliminary recognition.

Meet requirement 6: Organizations must demonstrate a reduction in risk of developing type 2 diabetes among completers in the evaluation cohort. They must show that at least 60% of all completers achieved at least one of the following outcomes:

• At least 5% weight loss by 12 months after the cohort began or
• At least 4% weight loss and at least 150 minutes a week (on average) of physical activity 12 months after the cohort began or
• At least a 0.2% reduction in HbA1C.

Meet requirement 7: Organizations must show that at least 35% of completers in the evaluation cohort are eligible for the yearlong National DPP lifestye change program based on either a blood test indicating prediabetes or a history of gestational diabetes. The rest must be eligible on the basis of a high score on the ADA/CDC Prediabetes Risk Test,^a,b. For an additional 2 years of full recognition (for 5 years total), organizations must meet the following requirements:

• Eligible participants in the evaluation cohort must have been retained at the following percentages:
  • A minimum of 50% at the beginning of the fourth month since the cohort's first session.
  • A minimum of 40% at the beginning of the seventh month since the cohort's first session.
  • A minimum of 30% at the beginning of the 10th month since the cohort's first session.

Organizations can receive full recognition for a period of 3 or 5 years. They can stay at this level for 3 years if they continue to submit data every 6 months.

^a Evaluation for these requirements based on all participants attending at least 3 sessions during months 1 to 6 and whose time from first session to last session is at least 9 months. At least 5 participants per submission who meet this criterion are required for evaluation.

^b All Medicare Diabetes Prevention Program beneficiaries must have a blood glucose test for eligibility.

Umbrella hub arrangement

To help expand the reach of the National DPP, CDC supports umbrella hub arrangements (UHAs). These connect community organizations with health care payment systems. UHAs allow organizations to seek timely, sustainable reimbursement for the National DPP lifestyle change program. Each UHA is created by an umbrella hub organization and includes subsidiaries and a billing platform for submitting claims.

UHAs can reduce the administrative burden for organizations offering the National DPP by:

• Aggregating DPRP data.
• Sharing CDC recognition status.
• Operating as a Medicare Diabetes Prevention Program (MDPP) supplier.
• Helping community organizations (such as pharmacies) receive reimbursement more quickly.
• Helping expand the reach and sustainability of National DPP.

For more information about UHAs, see the National DPP Coverage Toolkit.

Case study

School of pharmacy modifies curriculum to improve access to the National DPP lifestyle change program

In 2019, a community-minded developer built a grocery store in a low-income area in Richmond, Virginia. The developer recognized that the neighborhood would also benefit from a community education center that focused on healthy lifestyles. The Virginia Commonwealth University (VCU) Health Hub was created to meet this need.

To support these efforts, the VCU School of Pharmacy partnered with the VCU Health Dietetic Internship Program to offer the National DPP lifestyle change program. Teams of dietetic interns and pharmacy residents lead weekly classes, as well as grocery store tours, cooking classes, and physical education programs.

Tier 3 in Action: Offer the National DPP lifestyle change program

VCU also adapted its Health Promotion and Communication in Pharmacy Practice course to include elements of the National DPP Lifestyle Coach training. This mandatory first-year course contained much of the required content, such as motivational interviewing, social determinants of health, health literacy, communication with older adults, and smoking cessation. Students received their National DPP Lifestyle Coach designation at the end of the semester.

Keys to success

To ensure the success and sustainability of its efforts, the VCU School of Pharmacy:

• Integrated Lifestyle Coach training into its PharmD core curriculum.
• Paired pharmacy students with participants to serve as individual Lifestyle Coaches between sessions to increase retention.