Diet-related diseases account for more than 80% of U.S. healthcare spending. It’s an astounding statistic, and one that has consistently challenged an American healthcare system that is skilled at the treatment of these diseases — but largely falls short in prevention of diet-related sickness. Relatedly, only 1 in 10 Americans eat the recommended amount of fruits and vegetables. The produce industry has dutifully promoted, marketed and innovated to help overcome this consumption barrier and while there have been pockets of success, consumption has largely not budged despite nearly every American knowing they should be eating more fruits and vegetables.
When we put these two realities together, it becomes increasingly clear that healthcare must be part of the solution. Enter produce prescriptions. So what are they exactly? Simply put, the “prescription” is a dollar amount exclusively for fruits and vegetables and is financed by the healthcare system. Patients are prescribed fruits and vegetables (often alongside traditional pharmaceuticals) to help treat or manage a diet-related disease. Models can differ by community, with some patients receiving a pre-loaded card redeemable at a grocer, and others getting a produce assortment delivered directly to their home. Regardless of the model, patient healthcare outcomes are measured for efficacy of managing disease, much like a pharmaceutical intervention.
A Prescription for Better Outcomes
For conditions such as diabetes, which costs the public and private U.S. healthcare system more than $400 billion annually (1 in 2 Americans are diabetic or prediabetic), produce prescriptions can be highly effective and a cost-efficient tool.
A review of 11 Produce Prescription studies found significant improvement in weight/BMI, blood pressure, glycated hemoglobin (HbA1c), blood glucose, and/or blood lipid levels, even over the relatively short durations of many of these interventions, with impacts on diabetes management and glucose control (i.e. HbA1c) consistently showing beneficial effects. A recent study on Medically Tailored Meals (a “cousin” of the ‘Food is Medicine’ concept to produce prescriptions that provides fruit and vegetable-rich ready-to-eat meals to a smaller subset of more severely ill patients) could save more than $32 billion annually to the healthcare system.
The evidence is compelling, but produce prescriptions are not yet considered a standard practice of clinical care. Today, more than 100 programs exist around the U.S., with states like North Carolina, California, and Massachusetts implementing through Medicaid-sponsored programs. Under the Biden Administration, during the White House Conference on Hunger, Nutrition and Health, the U.S. Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS), encouraged states to submit proposals that would allow states to implement Food is Medicine interventions, like produce prescriptions. Several states have — or are pursuing — that option.
Current HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Oz (both of whom have been vocal critics of the U.S. food system) have not yet publicly signaled whether they will champion Food is Medicine interventions. However, they certainly fit nicely into the goals of addressing chronic disease through President Trump’s Make America Healthy Again movement so the industry should be hopeful. Two key areas to monitor in this space are potential cuts to Medicaid (which could limit states’ ability to take on new initiatives like produce prescriptions) and Secretary Kennedy’s well-documented criticism of crop protection tools, including those used by the produce industry.
Additional areas of opportunity within the healthcare system include the Veterans Administration and Indian Healthcare Services (two fully integrated federal healthcare systems). After considerable advocacy by groups, including the International Fresh Produce Association and the National Produce Prescription Collaborative, modest funding was made available to pilot produce prescriptions. The initial data from these projects are showing promising results.
Ultimately, we would like to see all insurance — public or private — cover produce prescriptions as a standard practice of clinical care. Typically, private insurance follows the Medicare reimbursement schedule which is why the federal government plays such an important role.
The path to approval in this space can be tricky, as evidenced by recent news on whether the government will — or will not — cover GLP1 interventions.
Scaling Up: A Market Opportunity
Focusing just on the U.S. healthcare system, Medicare, Medicaid, VA, IHS, TRICARE, and the Children’s Health Care Insurance Program (CHIP) cover roughly 150 million Americans. When we overlay the percentage of Americans living with or at risk of diet-related disease and those who are food insecure, in Medicare alone we can approximate that up to 30 million individuals could be eligible for produce prescriptions. Assuming a modest $40 per month produce prescription benefit per person, this could translate to $14.4 billion annually in fruits and vegetables just within Medicare.
One might be asking — what will this do to the existing spend of customers? A healthcare system in North Carolina issues a $40 a month produce prescription loaded onto a grocer’s loyalty card.
Shoppers can purchase the fruit and vegetables of their choice (so long as there’s no added sugar, fat, or salt). Data shows that customers are redeeming twice that amount in combination with their own dollars — an increase any healthcare provider or retailer would be pleased to see.
Important to note is that while the U.S. is the farthest along in testing produce prescriptions (largely due to the high rates of diet-related disease) — many other countries such as Canada, Mexico, the UK and Australia are not all that far behind in overweight and obesity rates, which often lead to these diseases. Researchers are closely monitoring U.S. outcomes to see how they could potentially be implemented elsewhere. Understanding how countries with a single healthcare system manage something like produce prescriptions may signal if and how these programs could be implemented more globally — a tremendous opportunity for produce industry growth.
For an intervention that has only been around for a few years, produce prescriptions represent a chance for the produce industry and healthcare system to realize its full potential. But to see success, we must boldly drive forward advocating for policy and research that will result in embedding produce prescriptions as a standard practice of clinical care.
