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
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
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
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
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
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
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
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
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
Decide which incentives you would like to offer employees for program
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
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
Assist you in deciding which incentives should be offered to employees for
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
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
Introductory letter as a paycheck stuffer
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
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 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
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
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