The House of Representatives and the Senate have both reintroduced legislation that would expand Medicare telehealth services for patients at risk for developing diabetes. The PREVENT DIABETES Act has the support of approximately 40 stakeholder organizations, as well as bipartisan support from both Democrats and Republicans, which is a significant factor in any legislation’s chances of success.
The PREVENT DIABETES Act was reintroduced to the House of Representatives in April by a bipartisan group of members of the House Energy and Commerce Committee. The bill would increase access to an existing Medicare program for diabetes prevention by providing telehealth access, while Medicare’s permanent coverage policies only allow access to the Medicare Diabetes Prevention Program (MDPP) through in-person appointments. This requirement presents a problem for many patients, particularly those in rural areas and some urban areas.
The legislation, H.R. 7856, requires that any individual enrolled in the MDPP, a structured behavioral health program, have
no prior diagnosis of diabetes other than gestational diabetes. There would be no lifetime limit to the number of times the patient can enroll in the MDPP program, which is typically a 12-month behavioral intervention. Supporters of the bill include Reps. Diana DeGette (D-Colo.), Gus Bilirakis (R-Fla.), Jason Crow (D-Colo.) and Kim Schrier (D-Wash.). However, the bill also has the support of two members of the U.S. Senate, Tim Scott (R-S.C.) and Mark Warner (D-Va.). Scott introduced the Senate version of the bill in April.
Medicare coverage of continuous glucose monitors (CGM) does not include use in prediabetic patients, although physicians can write a prescription for a CGM for these patients. The FDA recently cleared a CGM for over-the-counter use, which the agency said was prompted by concerns over health equity and access. The Centers for Medicare & Medicaid Services (CMS) had acted unilaterally to temporarily offer telehealth coverage to beneficiaries to the MDPP program, although CMS stated in the Medicare physician fee schedule for 2024 that it remains concerned about the potential for fraud and abuse of these services when delivered via telehealth.
A group of 39 stakeholders, including the American Diabetes Association and the Endocrine Society, voiced their support for the PREVENT DIABETES Act in April. These supporters cited statistics indicating that fewer than 5,000 Medicare beneficiaries had taken part in the program as of the end of 2022. This was seen as conspicuous given that approximately 500,000 Americans had participated in MDPPs under private payer coverage. The lack of coverage for virtual participation is seen as one of the more significant impediments to participation, which is due in part to the small number of providers that are certified to offer these services.
The PREVENT DIABETES Act had previously been introduced to Congress in 2021, at which point the bill had the support of a bipartisan group of 10 House members. H.R. 2807 had been introduced to both the House Energy and Commerce and Ways and Means Committee, but never gained significant traction. The Senate version, which had the support of eight Senate members, was similarly stalled in committee.
The current version of the PREVENT DIABETES Act has the support of the Advanced Medical Technology Association (AdvaMed), which stated that more than 38 million Americans already suffer from diabetes. However, AdvaMed also stated that nearly 100 million adults in the U.S. are prediabetic, adding that the direct and indirect cost of diabetes is nearly $413 million per year.
Scott Whitaker, President and CEO of AdvaMed, said rapid innovation by member companies “now enables patients to better detect prediabetes and prevent the onset” of Type 2 diabetes. Whitaker stated, “it is critical that these life-changing and lifesaving medical technologies are available to patients in even the most remote communities.” He thanked the authors of the House version of legislation for advancing the PREVENT DIABETES in the Energy and Commerce Committee.
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