Revising the Sustainability Plan for the National Diabetes Prevention Program

The National Diabetes Prevention Program is a yearlong lifestyle intervention for adults at high risk of developing type 2 diabetes. The program is based on the highly efficacious yet resource-intensive intervention from the landmark Diabetes Prevention Program trial. This Current Issues article examines the successes and challenges in achieving financial sustainability for the NDPP, focusing on strengthening Medicare coverage, which is a key indicator of the program's long-term potential success. A major barrier is that Medicare reimbursement rates were initially based on incomplete cost estimates that excluded critical components such as participant recruitment and administrative support. Combined with performance-based payment models and frequent claim denials, these low rates have resulted in average payments of only $225 dollars per Medicare participant, leaving a considerable financial shortfall to program suppliers. Low payments have discouraged suppliers from offering the NDPP and may explain its limited uptake, with approximately 0.03% of eligible Medicare beneficiaries participating to date. In this research letter, we identify four strategies to improve sustainability. First, define the minimum cost of effective delivery using rigorous and comprehensive costing studies. Second, systematically reduce administrative burdens to lower indirect costs. Third, set reimbursement rates that reflect actual costs and consider hybrid payment models that both support access and reward outcomes. Fourth, plan for future scale-up by setting delivery targets that are aligned with available resources, while prioritizing the highest-risk populations. Firmly establishing a sustainable delivery model for the NDPP may be key to ensuring widespread uptake and preventing diabetes across the US.