Prime's Pat Gleason flags cost, timing gaps in type 1 diabetes screening | AMCP Nexus 2026

Health plans still lack solid evidence on when to screen for presymptomatic type 1 diabetes (T1D) and whether testing beyond high-risk groups is worth the cost, according to Pat Gleason, Pharm.D., assistant vice president of health outcomes at Prime Therapeutics.

Gleason presented “From Screening to Symptom Delay: Operationalizing Type 1 Diabetes Diagnosis for Managed Care” this week at the Academy of Managed Care Pharmacy (AMCP) Nexus 2026 meeting. In written responses to Managed Healthcare Executive prior to the session, he described where the care pathway breaks down for plans, why claims data can't spot missed T1D diagnoses and why he plans to focus on vaccine misinformation when he becomes AMCP president in April 2027.

At Eagan, Minnesota-based Prime, Gleason leads the clinical health outcomes assessment team. The team uses integrated medical and pharmacy claims data to find opportunities for pharmacy benefit programs and to measure their results after launch. He also negotiates value-based purchasing agreements with drug manufacturers.

Where type 1 diabetes screening falls short for plans

Screening relies on islet autoantibody (IAb) testing, which can detect T1D before symptoms appear. The test generally carries a list price of more than $100, Gleason said.

Timing adds another challenge. The test only picks up T1D once the immune system has started attacking the part of the pancreas that makes insulin, so a single negative result doesn't rule out the disease later. For that reason, Gleason said repeat IAb screening at ages 2, 6 and 10 has been suggested.

That timing closely tracks the first international consensus guidance on general population screening, published in Diabetologia in September by an expert panel convened by Breakthrough T1D. The guidance calls for a first antibody test between ages 2 and 4, with retesting at ages 6 to 8 and again at ages 10 to 15 for children who test negative, MHE previously reported.

That schedule is not currently recommended by the American Diabetes Association (ADA), but Gleason did say the ADA does recommend IAb screening for those with a first-degree relative who has T1D, as well as for people with symptoms or suspected T1D.

The ADA's 2026 Standards of Care in Diabetes call for offering autoantibody screening to people with a family history of T1D or other known high genetic risk. Those with multiple confirmed autoantibodies but no clinical disease should be referred to specialist care for staging and education and, potentially, preventive treatment, according to the ADA guidance. The ADA has pointed to Tzield (teplizumab) as a disease-modifying option for people with stage 2 disease, according to an ADA webinar on the update.

For plans, Gleason said the biggest operational gaps come down to two missing pieces of evidence: the best timing for IAb testing and whether testing the broader population is cost-effective.

What claims data can't show about missed T1D diagnoses

Gleason's work at Prime centers on real-world claims analysis, but he said that data has clear limits when it comes to T1D misdiagnosis or delayed diagnosis.

Diagnosis codes for type 1 or type 2 diabetes are sometimes entered before a diagnosis is confirmed as a “rule out” entry, he explained. In other cases, the coder enters the wrong code.

Medical records and lab results would be needed to sort out those cases, and neither is part of claims data. Without them, “the real-world analytics work I do at Prime can't answer the question” of whether T1D was misdiagnosed or diagnosed late, Gleason said.

Why vaccine misinformation is a managed care pharmacy issue

Gleason is AMCP's current president-elect, and he has previously said that combating vaccine misinformation will be a priority of his term.

Managed care pharmacists weigh scientific evidence alongside guidelines from government agencies, advisory committees and medical professional organizations, he said. They use that evidence to shape cost sharing, formulary placement and utilization management criteria. Those recommendations then go to pharmacy and therapeutics committees and coverage policy committees.

“When guidelines and advisory committee recommendations are influenced by discredited science and other non-scientific issues, managed care pharmacists need to look to other evidentiary sources to ensure their recommendations are based in scientific fact,” Gleason said.

He added that he sees AMCP as a leading voice for using sound scientific evidence so that folks can get medications and vaccines at prices they can afford. Vaccines are among the most cost-effective therapies in healthcare, saving both lives and money, he said. Outbreaks of vaccine-preventable diseases such as measles carry high healthcare costs, which in turn raise health insurance premiums for everyone.

“Managed care pharmacists are best positioned to help inform the public of the medical risks associated with not vaccinating and the potential financial risks,” he said.

Real-world evidence as an AMCP priority

Gleason is a past chair of the Journal of Managed Care & Specialty Pharmacy (JMCP) Editorial Advisory Board and an adjunct professor at the University of Minnesota College of Pharmacy. He's also an elected fellow of both the American College of Clinical Pharmacy and AMCP.

Beyond vaccines, his goals for his presidency build on his day-to-day work at Prime.

“I will strive to increase the development and use of high-quality, real-world evidence in managed care pharmacy decision making,” Gleason said.