Medicare Monday: New study highlights impact of variability in Medication Therapy Management programs

It’s almost the time of year for seniors to review their medications and select a Part D plan that best meets their needs. Included in Medicare Part D is the opportunity for qualifying beneficiaries to receive a medication check-up at no extra cost. 

This check-up, formally known as Medication Therapy Management (MTM), provides a comprehensive review of all medicines being taken by a patient, including prescription and non-prescription medicines. What happens during a check-up?

1. A pharmacist or other health care professional will discuss with patients how to appropriately take their medications to get the most benefit;
2. They will address any questions or concerns; and
3. They will provide a written summary at the end of the visit that can be shared with doctors and caregivers.

To qualify for MTM services, beneficiaries must meet set criteria. This includes having multiple chronic conditions, using multiple medications and meeting a set threshold of estimated annual drug spend.

While Medicare Part D plans are required to provide MTM services to beneficiaries meeting these criteria, a new study released last week in Health Affairs took a closer look.

The study examined more than 500 Part D plans and found wide variability in plans’ eligibility for MTM services, including determining which specific conditions or medicines counted toward the minimum requirements. The study found an association between the restrictiveness of a plan’s eligibility criteria and enrollment in MTM, with plans with more restrictive criteria enrolling fewer patients in MTM. This wide-ranging variability means some patients who might benefit from a medication review won’t receive this service, because they do not qualify based on the parameters set by a particular plan. This creates inequities in access to MTM services across Part D plans.

Robust MTM programs have the potential to improve patient outcomes while reducing overall health care expenditures. However, plans have been hampered by a lack of financial incentives to invest in and expand these programs. The Centers for Medicare & Medicaid Services (CMS) recognizes the current structure of the MTM program is not built to encourage greater participation, which could mean many Medicare patients who would benefit from MTM can’t take advantage of a full review of their medications. Expanded access to MTM services could help patients catch and resolve medication-related problems early and prevent costly complications down the road.   

Addressing these challenges is important for improving adherence and helping patients manage their chronic conditions. We look forward to seeing the results of a new pilot developed by CMS allowing plans greater flexibility to develop innovative strategies to encourage better medication use. The new pilot is set to launch in 2017.