Calif. Blues Plan Sees Promise in Diabetes Reversal Platform

Diabetes prevention and diabetes management are both key tenets of Medicare Advantage insurers’ approach to addressing this costly condition that impacts one in three Medicare enrollees. But one tech-savvy startup aims to popularize a third category — diabetes reversal — and early adopter Blue Shield of California says the program has achieved very desirable results in less than two years.

MA plans, on average, face an annual increase in diabetes drug costs of about 3% to 6%, according to Virta Health. That’s because their go-to strategies are promoting medication adherence and/or shifting treatment to different drug classes to try to manage the condition, maintains Steve Hastings, health plan sales leader with the San Francisco-based company. For example, a plan might transition a member from a sulfonylurea to a drug in an emerging class like glucagon-like peptide (GLP-1) receptor agonists or pursue a combination of drugs. “Virta comes to the table and says, ‘Hey, how about we just get them off the drugs altogether?’”

© 2022 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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