Q: Why diabetes?

A: Based on the statistics below, including the impact on patient lives as well as costs to employers, LPIHO decided to implement the Diabetes Program first. The Cardiovascular Disease Prevention Module is also available.

The latest statistics on diabetes are staggering. 23.6 million children and adults in the United States (7.8% of the population) have diabetes. 17.9 million of these people are diagnosed, while 5.7 million of these people remain undiagnosed. In addition 57 million people have pre-diabetes.

The total costs of diagnosed diabetes in the United States in 2007 were $174 billion. They included $116 billion for direct medical costs and $58 billion for indirect costs (disability, work loss, premature mortality).

The Agency for Healthcare Research and Quality (AHRQ) has created an evidence-based tool that employers can use to estimate how much diabetes costs them and the potential savings that would result from better management of diabetes. Please click here to be directed to AHRQ’s website which includes both the diabetes cost calculator and instructions for use.

These statistics and additional information can be found in the National Diabetes Fact Sheet, 2007.

Q: Why pharmacists?

A: Pharmacists are some of the most accessible, yet most under-utilized, healthcare professionals in medicine today. In addition to being medication experts, many pharmacists have experience and education in disease state management.

Q: What qualifies a pharmacist to coach patients?

A: Today, all graduating pharmacists receive their Doctor of Pharmacy degrees from an accredited institution, which constitutes approximately six years of schooling. Many pharmacy graduates opt to complete a one- to two-year residency program, and some continue on to complete a fellowship in a specialized area of practice. As a result, pharmacists receive six to ten years of education.

In addition to college, residencies and fellowships, many pharmacists complete certificate programs that focus on a specific chronic condition. LPIHO requires that any pharmacist participating in the program complete a certificate program for the chronic disease module(s) in which they wish to participate as a coach.

Q: Can we implement the program at any time?

A: Yes, you may. There is no specified enrollment period at this time

Q: How long is a typical implementation period?

A: Once contracts are signed, it takes approximately 90 days to implement a new program. Implementation includes selecting and training pharmacists for the program, working with Third Party Administrators and Pharmacy Benefit Managers, assisting the employer in marketing the program, and enrolling participants.

Q: What do I need to do to get started?

A: To begin, you should make contact with LPIHO to set up an employer meeting to review how the program works, explain the contract terms and pricing, and answer any questions. If an employer is a member of the Lancaster County Business Group on Health (LCBGH), the employer may contact the LCBGH Executive Director, at (717) 239-6954 to arrange the meeting.

Q: After the contract is signed, what are my program implementation responsibilities?

A: Employers are responsible for the following:

  • Obtain specific information, reviewed in detail during your initial meeting with LPIHO, from your Third Party Administrator (TPA) and your Pharmacy Benefits Manager (PBM).

  • Decide which incentives you would like to offer employees for program implementation

  • Work with LPIHO to customize program announcement and enrollment templates and to determine which marketing strategies you would like to use

  • Complete a brief employer questionnaire for LPIHO to accurately assess your implementation needs

  • Assist LPIHO in data collection from the TPA/PBM in order to receive an accurate and timely annual report of program results

Q: What are LPIHO’s program implementation responsibilities?

A: LPIHO is responsible for the following:

  • Provide you, the employer, with a list of claims information you must obtain from your TPA/PBM

  • Provide you with customizable templates for both program announcement and employee enrollment

  • Assist you in deciding which incentives should be offered to employees for program participation

  • Select and train a local network of pharmacists to serve as pharmacist coaches for your employees

  • Enroll participants in the program and assign each participant a pharmacist coach

  • Monitor the pharmacist coaches to ensure that they document all required information and that visits take place in a timely manner

  • Provide monthly invoices to the employer for employee/pharmacist coach visits

  • Notify the employer of any issues or concerns (incentives, missed visits, etc.)

  • Provide annual clinical, economic, and satisfaction reports

Q: How do we make employees aware of the program?

A: LPIHO has customizable templates that employers may utilize to market the program. In addition, previous employers have used methods such as:

  • Introductory letter as a paycheck stuffer

  • Company intranet

  • Letter sent from PBM to all employees using diabetic medication

  • Announcement in company newsletter

  • Announcement during company’s open enrollment

  • Work site visit from LPIHO team member explaining the program and answering employee questions

Q: What motivates employees to join the program?

A: Most employers offer a financial incentive in the form of waived copays for the following items:

  • Diabetes medications

  • Diabetes supplies (meters, lancets, test strips, etc.)

  • ACE inhibitors (a class of drugs used to treat blood pressure that also protects the kidney from damage by high blood sugar in patients with diabetes)

Some employers also waive copays on standard laboratory tests, eye doctor and dentist visits, and cholesterol and high blood pressure medication. Other employers chose not to provide any financial incentives; however, employee enrollment in this scenario is usually low and less than satisfactory.

Q: How does the copay waiver work with my insurance carrier?

A: There are three scenarios that LPIHO has encountered. Each work out fine depending on the agreement reached between you and your PBM:

  • Your PBM may be able to place a blanket copay waiver on entire classes of medications. In this scenario, a participating employee would have a waiver placed on all diabetes medications and supplies, as well as ACE inhibitors. When the employee receives these items, their copay is $0.

  • Some PBMs are not able to place a blanket waiver on classes of medications. In this scenario, participating employees notify their pharmacist coaches each time a new diabetes medication is added or a dose is changed. The pharmacist coach then notifies LPIHO’s Care Team. The Care Team member in turn contacts the appropriate PBM representative who can put the specific copay waiver in place.

  • Some PBMs do not offer either of the above scenarios. The employee must then pay the copay at the time of service and submit their receipt to the employer’s HR department for reimbursement.

Q: What are the employee’s responsibilities to maintain eligibility for the offered incentives?

A: Employees are responsible for the following:

  • Meet with their pharmacist coach on the pre-determined schedule

  • Notify the pharmacist 24 hours in advance if a visit will be missed and reschedule the visit as soon as possible

  • Keep all regularly scheduled physician appointments

  • Have regularly scheduled laboratory tests done as determined by employee’s physician

  • Stay up to date on all eye exams, dental exams and immunizations

  • Strive to meet goals set at each pharmacist coach visit

Q: How will we know our employees are compliant with the program’s requirements?

A: LPIHO monitors both the frequency of visits with the pharmacist coach and follows up with any pharmacist coach and/or participant who is outside of the agreed upon frequency of visits. LPIHO also monitors the frequency of required laboratory test results.

Any pharmacist who does not comply with the program guidelines is given a verbal warning, followed by removal from the program upon repeat offense. A new pharmacist coach is assigned to the participant.

Any participant who does not comply with the program guidelines is given a verbal warning from the pharmacist coach. Should such behavior continue, the LPIHO Coordinator contacts the participant to affirm their commitment to the program. If this does not resolve the matter, LPIHO recommends that the employer terminate the employee’s program enrollment.

Q: What are the costs associated with implementing the program?

A: There is a one-time administrative fee for each employee enrolled in the program. Additionally, LPIHO sends a monthly invoice for pharmacist visits to the employer.

Q: How will I know if the program is successful?

A: LPIHO presents the employer with annual clinical, economic and satisfaction reports, provided the employer obtains the necessary information from their TPA and PBM in a timely manner.

Q: What happens if our company changes insurance carriers?

A: LPIHO’s programs are portable, so even if your company changes carriers, the program continues without interruption.

Do you have questions or concerns that were not addressed here?

If so, please contact a member of LPIHO’s Care Team

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