Since 2017, our Diabetes Care Value program has sought to support people living with diabetes and those at-risk for the disease to help manage their health, and help blunt the costs associated with diabetes for patients and plan sponsors. In 2022, we announced an expansion to the program that included new tools and resources to help better prevent and manage this complex and chronic condition.
Today, the importance of addressing the growing diabetes epidemic, which affects more than 38.4 million Americans and can be overwhelming and costly to employers and plan sponsors remains. Holistic solutions that leverage the latest digital tools available can help to address the individual needs of each patient to support adherence and improved outcomes.
Diabetes Care Value includes coverage for the use of continuous glucose monitors (CGMs) under the pharmacy benefit. CGM integration enables greater convenience and provides key clinical data about a patient’s glucose levels. Blood sugar levels that go up and down can do both short term and long term damage to patients’ health. When clinically appropriate, CGMs can help members achieve their health goals with a lower total cost of care.
Together, the Diabetes Care Value program combines traditional pharmaceutical interventions with tools and resources from across Evernorth’s health services business to help patients better understand and manage their diabetes. In addition to coverage for CGMs within the pharmacy benefit, expanded components include to support and streamline uptake include:
- Predictive analytics that enable proactive outreach to eligible members and their prescribers to support shared decision-making surrounding the potential benefit and use of a CGM;
- SmartPA to streamline prior authorizations and ensure access to the appropriate therapy for members who are prescribed a CGM; and
- Specialized pharmacist support for members using CGMs to support uptake and ongoing adherence
Participating plans are also eligible for a plan discount for participating CGMs and discontinuation credits for certain preferred products through the program.
In addition to affordable diabetes treatments, tools like CGMs create a more comprehensive approach to diabetes management by supporting members and empowering plan sponsors to take proactive steps to manage this complex and costly disease.
And, because conditions are often interconnected, this comprehensive approach supports improved outcomes across a spectrum of chronic conditions. For example, in 2023, Diabetes Care Value, as part of our value-based SafeGuardRx platform, helped an additional 18.2% of enrolled patients at risk for heart disease and stroke start statin therapy. If all plans were to similarly increase statin use, we expect over 21,500 additional heart attacks could be prevented over the next 10 years.1
Additionally, the Diabetes Care Value program includes a preferred quality pharmacy network that can lower costs and improve adherence, National Preferred Formulary or utilization management tools to drive to the lowest net cost diabetes medications, and reimbursement opportunities when patients fall off therapy. In addition, we offer specialized support from the Diabetes Therapeutic Resource Center®.
Originally published on 8/31/22 and updated on 11/22/24.
1 2023 SafeGuardRx data
