Medication Therapy Management in Part D

Medication therapy management involves using clinical pharmacists to review a patient’s use of prescription medications, over-the-counter products and supplements to evaluate potential therapy problems and maximize the effectiveness of treatment.  Because research has indicated that not only does MTM improve quality, but it can lead to significant cost savings, CMS has required that Part D plans, including Medicare Advantage plans which have Part D coverage, identify certain classes of beneficiaries who could benefit from MTM and do an outreach to engage those patients in a comprehensive evaluation of their drug therapies.  But a new analysis from Avalere finds that many beneficiaries are not getting the benefit of MTM.  (Avalere Analysis)  Avalere says that about 25% of beneficiaries are eligible for an MTM intervention, but only 11% received any kind of review.   In looking at the top ten Part D carriers, MTM enrollment varied from 4.6% to 17.5%, but the actually receipt of a comprehensive medication review was between 2% and 74% of the enrolled beneficiaries.    Overall, a very small 1% of Part D enrollees received a CMR, much lower than the number who could likely have benefited from one.  Medicare Advantage plans did a better job, with enrollees in those being three times more likely to get a CMR and many of those had an actual intervention to improve care, such as a call to a prescriber or a change in therapy.  Part of the reason for the low use of MTM is that beneficiaries have to agree to participate and many don’t want to or don’t understand the potential benefit.  CMS could help by providing incentives for participation.  But Part D sponsors have little incentive to encourage MTM, as it is not currently a STAR measure.  They get some pressure from CMS, but until there are some teeth in the program, the plan sponsors won’t likely really make an effort to use MTM.