On this episode of Danatech Talks–a special series from The Huddle– Paola Acevedo, PharmD, CDCES, walks through how to simplify the process of prescribing diabetes technology. Paola discusses common pain points both clients and prescribers may face related to documentation, coverage and affordability, and accessibility. She also shares practical strategies, systems and workflows providers and practices can implement to help navigate through these potential challenges. This episode was supported by educational grant funding from Abbott. Explore the latest in diabetes technology as well as trainings and resources on danatech: danatech l Diabetes Technology Education for Healthcare Professionals Explore danatech’s technology affordability tool: Diabetes Technology Affordability Options Listen to previous episodes of our Danatech Talks diabetes technology series: https://thehuddle.simplecast.com/episodes/basics-diabetes-technology-for-health-care-professionals https://thehuddle.simplecast.com/episodes/understanding-cgms-and-interpreting-data-for-beginners
On this episode of Danatech Talks–a special series from The Huddle– Paola Acevedo, PharmD, CDCES, walks through how to simplify the process of prescribing diabetes technology. Paola discusses common pain points both clients and prescribers may face related to documentation, coverage and affordability, and accessibility. She also shares practical strategies, systems and workflows providers and practices can implement to help navigate through these potential challenges.
This episode was supported by educational grant funding from Abbott.
Explore the latest in diabetes technology as well as trainings and resources on danatech: danatech l Diabetes Technology Education for Healthcare Professionals
Explore danatech’s technology affordability tool: Diabetes Technology Affordability Options
Listen to previous episodes of our Danatech Talks diabetes technology series:
Dana Moreau
Welcome to Danatech Talks, a special series from ADCES's The Huddle, Conversations with the Diabetes Care Team, powered by ADCES. I'm Dana Moreau of Danatech, and in this series, we delve into the latest in diabetes technology, bringing you expert insights, clinical strategies, and the innovation shaping patient care today. So whether you're new to diabetes technology or looking to take your expertise to that next level, Danatech Talks is your go-to source for real-world knowledge.
So as many of us in the diabetes space have experienced, prescribing diabetes technology devices isn't always the most straightforward process. Today we're joined by Paola Acevedo, who's going to share practical tips and advice on how to make this process simpler and less intimidating for both the patients and the providers. Special thank you to Abbott for providing educational grant support for this episode. Paola, welcome to The Huddle.
Paola Acevedo
Thank you so much for having me, Dana. I'm really excited to be here. And as usual, it is a pleasure seeing you.
Dana
And again, we are so happy to have you. Paola is also a member of our Diabetes Technology Committee. again, such a welcome guest. Before we get into discussion today, would you like to tell our audience a little bit more about yourself and why this topic is so important to you?
Paola
Yes, absolutely. I'm an ambulatory care clinical pharmacist, which means I'm embedded in a community clinic and primary care, basically helping patients manage their chronic conditions. I'm also board certified in advanced diabetes management, and I'm a certified diabetes care and education specialist. But most of all, I like to say I'm a patient and a diabetes care team advocate. I find this topic very important because I've seen firsthand how life-changing diabetes technology can be when patients can actually get their hands on it. And I've also seen on the back end how frustrating it can be for both patients and the care team when the prescribing process becomes a barrier. And so my goal is to make that process simpler for everyone. I spend a good chunk of my time educating both the patients and the care team, building the workflows and opening lines of communication, basically clearing the path to ensure that patients have access to this life-changing technology. So this conversation just really ties back to what I love most about my job, which is bridging gaps between the availability of these great technologies and these great diabetes treatments and the real world use and implementation so that every person with diabetes can benefit.
Dana
I love all of that and those are such great goals. You've really set the stage here for today's discussion about simplifying the prescribing process for diabetes technology. So let's start at the very beginning. When should providers consider introducing diabetes technology into patient care?
Paola
The easy answer is that every person with diabetes should be offered diabetes technology at some point in their trajectory. The harder decision or question is when should it be offered. And I've noticed that timing really shapes how patients perceive and use technology and therefore how impactful it is in their care. But it's really going to depend on various things like the type of technology. And as one of your previous guests explained beautifully, there are many categories of diabetes tech. You've got CGMs, insulin delivery devices, smart pens, phone apps, and the list goes on. I like to remind providers that there is no perfect single time, but there are some key moments in our patient care interactions that we should keep an eye out for to help us determine when it might be a good time. So let's say a patient reports pain with finger pricks, which is a very common real life scenario, or they express interest in maybe changing an aspect of their lifestyle, or you notice that they could benefit from more insight about their glucose patterns. Or let's say you decide to start a treatment or diabetes medication and you'd like more data to optimize the dose. Those are all perfect segues to introduce diabetes technology as a tool in patient care.
Dana
Again, there's clearly not just one way. It sounds like there's a number of ways to introduce it. When, I think can also really shape how patients perceive the use of the technology. So once a prescriber does determine that it's time to prescribe, what's that first step? And tell me about some of the subsequent steps as well.
Paola
Absolutely. I feel that the first step should actually be taken before the provider decides to prescribe diabetes technology. I've noticed it's helpful to have a starting point before jumping into all of the nitty gritty and the logistical aspects of it, like where does the prescription go? Is there a prior auth required? What documentation do I need? When I first started learning about diabetes technology, I found it helpful to search for already existing guides that summarize the available options because there's so much out there and it could be so overwhelming, you need a starting point. I did come across several resources, including Danatech. So this is a full circle moment for me being on the podcast.
Dana
I love that answer!
Paola
I found CGM and other diabetes tech device guides, which really helped me to learn the basics. I was able to compare features and then it linked me to additional resources where I learned how to prescribe the devices. And the good news, you rarely have to reinvent the wheel. Again, although there's a lot of options out there. I cannot emphasize this enough though, it really helps to lay the foundation so that you know the arena before you step in.
Dana
Right. I love that you're emphasizing that kind of having this foundation before you dive into the details, knowing where to start makes all the difference. But let's move into the topic people don't like to talk about, but we live every day. What are the biggest pain points from your perspective? What are the most common forms or documentation requirements that tend to trip people up in this process?
Paola
And like you said, this is the most frustrating aspect of it, I would say. One of the biggest challenges that I've noticed is just finding the correct form or the best way to prescribe. So depending on the insurance, the device type, and where the benefit is coming from, there are several types of forms available. And when I say where the benefit is coming from, what I mean by that is that some of the devices are covered under the pharmacy benefit of the insurance plan, which means we can prescribe it to the pharmacy, the patient can go and pick it up at the pharmacy. Whereas some devices are covered under the medical benefit. And that means that we would have to use a durable medical equipment supplier, DMA supplier. So that is gonna make, I say, the biggest difference in what forms or what documentations you're gonna need. But sometimes it's as simple as sending the prescription directly to the pharmacy, easy peasy. Sometimes you need to fill out a certificate of medical necessity or pump therapy order form. So there's a lot out there not to mention the fact that these can be filled out by paper or electronically, and then that they may require a prior authorization, which is a whole separate form and process on its own. So where can providers find this information? Once again, I found that using the guides were helpful, but the most accurate information will be found on the insurer's website or making a phone call. But typically there are formulary or preferred drug lists, prior authorization grids. In case of Medicare, there's the Medicare coverage database website. So, there's information out there. In general, the pieces of documentation that are needed are going to be a diabetes diagnosis, type 1, type 2, gestational, so on. A recent A1C, the most recent provider note, specifying the diabetes treatment plan. And I'd recommend adding a little bit of rationale as to how that technology is going to benefit the patient and medications the patient is on, especially if there is an insulin use requirement by the insurance plan. Most of this information can be found likely in the provider's note, but you may have to search a little bit in the chart, the labs, maybe the prescription history log, or perhaps another team member's note, like the clinical pharmacist, the CDCES, nurse educator, et cetera.
Dana
And that's all incredibly helpful. I know even trying to populate some of the danatech stuff, I can't always find everything I need. And then when I do find it, it may actually be outdated a month later. So giving people all these options to find the documentation, very helpful. And when you're describing this process, again, finding the information of what to provide, it sounds like there might be differences depending on what kind of technology we're talking about, like thinking about pharmacy versus DME. Do you think there's any big differences between prescribing CGMs versus like pumps and AID systems or is it fairly similar?
Paola
Yes, definitely there are differences, but it helps to know that ordering and prescribing these devices tends to follow a general formula. For example, the type of device you want to prescribe, instructions on how often to change a specific aspect of the device, the quantity that the patient should get per month, the refills, and whether or not you have to prescribe additional supplies alongside. But the biggest difference I've noticed is how you can prescribe or order these devices. And so, once again, that circles back to the, is it a pharmacy benefit or is it a medical benefit? That will help determine how we're going to prescribe it. Most CGMs can be prescribed directly to the pharmacy, through that pharmacy benefit, whereas most pumps are covered under the medical benefit. And so we're using DME suppliers. There are some exceptions with insulin pumps, for example, the disposable patch pumps, there has been an increase in coverage under the pharmacy benefit, which I think makes it a little bit easier for the team. And for patients as well.
Dana
And kind of thinking about that, not to throw anybody under the bus, but what are some of the mistakes and oversights that you see other HCPs, not yourself, because you are the expert, making when prescribing this tech? What should they do different, and again, to avoid any frustration they might encounter?
Paola
This is a really good question. And I'm going to circle back to a response I said earlier, but missing that foundational knowledge that I mentioned. And the reason I say that is that it's pretty easy to get lost in the sauce with all that's available, which can lead to that frustration and the reduced prescribing, which can lead to the thought of, I don't have time for this. Now, apart from that, I would say the more technical mistakes I've noticed are incorrect supply quantities. And with these devices, CGMs, AID systems, pumps, et cetera, it's very important to prescribe the appropriate quantity of each item so patients don't run out too early. So I'll give you an example. Writing for a quantity of two sensors when a quantity of three sensors is what's required based on a 10-day sensor wear. In that case, your patient will run out in about 20 days instead of 30 days. Another one I've noticed is not prescribing enough refills. And again, that's leading to gaps in that patient care where patients are running out early. So in general, I recommend provide a year's worth of refills, especially if it's a monitoring device. Our patients should have access to monitoring their glucose levels without barriers such as lack of refills.
Dana
Agreed, agreed. So let's pivot for a minute to something we all rely on every day, whether we love it or not, the EMR. How can EMRs help or do they sometimes make life harder in this process that we've been discussing?
Paola
Yes, and I find this question to be so relevant right now because in my organization, starting this Monday, we just switched to EPIC. Now, I love Epic, it's exciting, but it's been interesting and I'm being kind. So, perfect segue. EMR is just like technology as a whole, as you mentioned, can be both our best friend and our biggest challenge. When they're set up really well with smart phrases, templates, order sets, they can save a lot of time and standardize the workflow beautifully. However, when those tools are not built in yet, you can end up with everyone documenting in different places or in different ways. And I feel that's when things start to fall apart and where we can increase our workload instead of making things easier. My recommendation is to invest a little bit of time upfront in building certain EMR shortcuts, creating a CGM quick order set, perhaps a standard documentation template, or some folks might call that a dot phrase. Or even a shared note type that you're sharing with other colleagues so that you're working smarter, not harder. You're leveraging that EMR in your favor.
Dana
Okay. Yeah, it sounds like a little like knowledge of this smart phrases set up really goes a long way when you're working with these systems.
Paola
Right, because everyone can document in the same way. And, again, it helps to sort of get rid of the tediousness that comes from, you where do I find this? And this is missing this particular sentence, and now we have to add an addendum. So again, if you take the time initially to build a template that the team can use, I promise you it'll save a lot of time.
Dana
Let's talk about what happens once the prescription is in motion and patients start asking questions. When they raise concerns about things like comfort, usability, cost, what's your go-to way to address these types of questions?
Paola
And you are going to get a lot of questions about these things. What I find works well for me is to start by listening to the patient's concerns and asking a lot of questions, being curious about what the concerns are and where they're coming from. They might be coming from fear or past experiences, whether personal or maybe hearsay or rumors. And so it's very important to not dismiss those concerns. That's the first thing I want to say. When it comes to comfort and usability, I like to explain that the diabetes technology and devices have come a very long way. They're smaller, they're gentler, more user friendly, more discreet. Since I've also worn several of the CGM devices and use a traditional glucose meter, I often also speak from my own experience. And I might say something like, well, personally, it hurts more to prick my finger. And when I use a sensor, I might feel a small pinch, most of the time, nothing at all. I do like to explain though that everyone is different, my pain tolerance is different than yours, my skin sensitivity is different than yours, but at least I help to connect with them in that way by letting them know I've used the devices. I also like to ask, have you seen or spoken to someone who uses this device, just to see how familiar they are with how it functions and where I might need to fill in some gaps with their knowledge to better address those concerns.
Dana
Yeah, and I think that's a really compassionate approach. I'm sure they appreciate kind of your lived experience. Just, you know, makes you so much better, I think, at what you do, having lived through it as well. But speaking of kind of some of these topics, we're going to move into one that is very popular right now. And that's the idea of affordability or the coverage. Approaching it with your patients to prevent headaches later. What are some of your thoughts on this?
Paola
When it comes to cost, this is a big one. It's a big question. The first thing I'll say is don't assume what someone can afford. For example, most of the patients I work with have most, if not the entire cost of these devices covered, and I work for an FQHC in DC for reference. On the other hand, Medicare commercial and employer-based plans may have copays, and these can range from zero dollars to insert any number, so it varies. If cost is found to be a barrier though, I do like to offer different kinds of solutions. So perhaps can we use a prescription drug savings card? Can we maybe leverage our FSA or HSA cards? Can we maybe use some subscription-based savings? So a few of these devices may offer a percentage off if you subscribe for recurrent orders in the moment. And then I tell patients to cancel it shortly after as a secret. And a bonus tip, I think this has been one of the most helpful things, is connecting with the local reps for additional ideas or perhaps to get some samples to patients who have access issues. Some of these technologies like CGMs can be beneficial even if used in a short term with a sample. It really illuminates a lot of what both the provider and the person with diabetes are probably not seeing. I feel like it's very important to set expectations with the patient as you start to have conversations about diabetes technology and not just the cost, but, you want to explain what's going to happen next, that there may be a prior authorization or a specific follow-up step, that they're going to hear from other team members. Perhaps you want to talk about timing of all of this. Hey, we're going to call you back in about a week or two, so on and so forth. I would say that we should normalize being honest with our patients about not knowing everything, especially cost, because it is a mystery, while at the same time offering our willingness to help figure it out and solve the problem once we get there.I feel like that helps foster that patient and provider collaboration. It's okay to tell a patient, look, the cost, if any, is gonna be determined by your insurance plan and sending the prescription is the first step to helping us find out. Or something more broad, there are a few devices out there and coverage can vary. Let's see what your insurance prefers or what might work best for your insurance.
Dana
And I'm going to put in a little plug for Danatech. We did recently put up the technology affordability tool, which showcases all the programs that the manufacturers and others have to discount the products from free trials to couponing to a variety of other topics. Okay. So setting expectations, looking at resources, it really is a powerful takeaway and it ties right into how teams can make this whole process more efficient. What simple systems or habits have you seen clinics use to make prescribing smoother? Checklists, templates, staff workflows, what works?
Paola
Great question, Dana. I found that having a checklist or some sort of cheat sheet, once again, a smart phrase that we can use in the EMR, that provides the necessary information that the care team needs to complete the process successfully. I would say consider including on this cheat sheet or checklist what are the different device types, maybe some basic features like sensor duration, patient population that's approved for, the recommended quantity refills, et cetera. You might want to have some basic insurance criteria. Does the patient require insulin? Does the A1C need to be a certain level? And of course, the documentation requirements that I mentioned earlier. In addition, once the correct forms have been identified, and what I mean by forms is, remember we talked about an order form or a PA form, et cetera. Once you've identified what the correct forms are for those devices and for the insurance types that are most common in your area, I found that having a specific team member assigned to complete those forms have been extremely helpful. For example, the team nurse, maybe a medical assistant, a patient care coordinator, the CDCES, a clinical pharmacist. Those are just some ideas. I know each team works a little differently. But that way, the process is streamlined and centralized. And then that also allows that team member to develop into this device champion, if you may, for that particular organization, because they become very comfortable and efficient in the process.
Dana
I love that idea of designating a device champion. That seems like a great way to build internal expertise and build out some consistency as well. Let's wrap up this section with something very practical that our listeners can put into action right away. If you could give health care professionals one time-saving hack or golden rule for prescribing diabetes technology, what would it be?
Paola
I would say a medium effort and high reward trick is to save these prescriptions under your favorites or in some sort of order set if your EMR allows. And that really grants you the ability to quickly and easily find what you need. Some EMRs even have the ability to share that favorites list with your colleagues or share those order sets with other members of the team to once again standardize the process. I can't emphasize that enough. That standardizing really saves time. This removes the barriers of trying to memorize specific quantities and details. And it may take a bit of time initially, like I said, it's medium effort, but once completed, it is a true time saver. Going back to those forms as well, once you've identified the correct forms, I recommend saving them in a folder on your computer, or maybe even printing several blank copies for easy access for the entire team. In summary, what I would say is standardize your process and personalize your care. That's how you make tech prescribing a bit faster for you and more meaningful to the patient. You can spend less time worried about the headaches of the hows and the whys and spend a little bit more time talking about what may be the best technology for that person and how they can use it to manage their diabetes better.
Dana
That's a perfect summary. Standardize your process, personalize your care. I'm going to steal that. 100% you're going to see it.
Paola
Love it. Let's put that on a shirt. Let's put that on a shirt.
Dana
Okay, so let's talk about what you would tell a provider who is hesitant to start prescribing diabetes technology because it feels too complicated. And hopefully there are fewer of those people out there right now, but let's get that down to zero.
Paola
That would be ideal. Well, first, I do want to acknowledge that this can feel and is complicated and complex, especially at the beginning. The good news is, as I mentioned before, is that you rarely have to reinvent the wheel. There are many resources available to help providers learn basic information. And that can at least set the stage to help people start exploring the concept of prescribing technology. I would also say that it's important to leverage your team members, both internally and externally. Is there a clinical pharmacist or a CDCES embedded in your clinic or practice? Or perhaps a nurse with special interests or experience in diabetes? Externally, this might look like collaborating with the reps from various manufacturers that produce such technology. They have tons of guides, information on how to prescribe the product, insurance coverage, and honestly, without them, this would be a lot harder.
Dana
A lot has changed, a lot stays the same when it comes to making prescribing easier, or in some cases more difficult places. But what do you think the biggest changes have been and what do you see coming down the pipeline?
Paola
Oh, okay. The biggest changes I've seen recently have been access, provider and patient awareness, and I would say interprofessional collaboration. I feel insurers are starting to realize the value of diabetes technology and slowly removing or at least adjusting the criteria or what I like to call barriers. And of course, patients are asking for this technology earlier on because they're seeing it on other folks, they're seeing it on TV, they're seeing it everywhere. And then in terms of the team, feel multidisciplinary teamwork has also evolved tremendously. We often have CDCESs and pharmacists and nurses embedded within the team and they're sharing workflows and tools with providers to make this process a lot easier and more seamless.
Dana
Before we close up, is there any final thoughts that you want to share?
Paola
Yes, I will say don't let it scare you. Don't let diabetes technology scare you. It offers both providers and patients a multitude of opportunities to take diabetes management to that next level. Tech can be used as a tool to help both providers and patients feel more confident and knowledgeable in managing this condition, which can translate to those real life outcomes, improved quality of life, decrease in distress, positive health outcomes and the provider's ability to provide better care overall. So what I would say is start somewhere, but you're also not alone.
Dana
That’s great. Thank you, Paola, for sharing such practical and pretty encouraging insights, I'm gonna say. I know our listeners will walk away feeling more confident about helping their patients access and use this diabetes technology, which is so critical to people's well-being.
Thank you again to Abbott for supporting this episode. You've been listening to Danatech Talks, part of The Huddle: conversations with the diabetes care team. To explore more resources and guides that have been mentioned in today's discussion, visit danatech.org. And until next time, thanks for tuning in. The information in this podcast is for informational purposes only and may not be appropriate or applicable for individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a health care professional. Please consult your health care professional for any medical questions.