In 2002, Knowler et al. reported results of a landmark study — a large, randomized, controlled trial comparing a behavioral intervention with medical therapy in the prevention of diabetes.1 Over a mean follow-up period of 2.8 years, the lifestyle-modification program, known as the Diabetes Prevention Program (DPP), reduced the incidence of diabetes by 58% as compared with placebo among people with elevated fasting and post-load plasma glucose concentrations. Metformin reduced the incidence of diabetes by 31% as compared with placebo.

Despite these findings, insurers have been slow to provide coverage for DPP-like interventions. In 2016, the Centers for Medicare and Medicaid Services piloted the program and determined that it improved the quality of patient care and reduced net Medicare spending, prompting a goal of expanding the DPP nationwide by 2018. Although coverage of metformin has been ubiquitous since it was introduced in the United States in 1995, many private insurers started covering the DPP only recently. …..more