For patients living with multiple chronic conditions, managing medications can be a challenge. That’s why Medication Therapy Management (MTM) in Medicare Part D is offered to certain eligible enrollees managing multiple medicines or managing chronic conditions.
The Part D MTM program has the potential to help improve medication use, but there have been a number of challenges with the current program that limit its effectiveness.
Members of Congress have been looking to address issues with MTM, and in fact, the House Energy and Commerce Committee is holding a hearing today to look at ways to improve MTM in Part D. Also recognizing some of these shortcomings, the Center for Medicare and Medicaid Innovation (CMMI) recently announced a Part D Enhanced MTM Model Test to begin in 2017. The House Energy and Commerce Committee is also holding a hearing today to look at ways to improve MTM in Part D.
While the overall design of CMMI’s Enhanced MTM Model Test is promising—such as providing better incentives for Part D plans to offer MTM services and providing plans with flexibility to target beneficiaries most in need of these services— there are ways to strengthen CMMI’s efforts and enhance the benefits of MTM by allowing biopharmaceutical manufacturers to explore innovative partnerships with Part D plans. CMMI should evaluate other ways by which Part D plans can improve medication use, appropriate prescribing, and other aspects of suboptimal medication use. For example, manufacturers can contribute to better use of medicines by providing disease education materials that pharmacies can distribute.
Improved adherence has the potential to provide big savings to the health care system. A 2012 study by IMS Health found better use of medicines could eliminate up to $213 billion in U.S.health care costs annually, representing 8 percent of the nation’s health care spending and the areas with the greatest potential savings were improved medication adherence ($105 billion) and earlier evidence-based treatment ($39 billion).
While testing new MTM strategies is important for beneficiaries and the Part D program, it is also important to allow all stakeholders the ability to explore innovative partnerships to enhance the MTM program. Prohibiting Part D plans from leveraging the core competencies of biopharmaceutical manufacturers, particularly in a test environment, could hinder the potential success of the demonstration.
Ashley Flint Ashley is a former Senior Director in the Policy and Research Department at PhRMA where she led day-to-day policy analysis related to the Medicare Part D program. Prior to PhRMA, Ashley worked as an Associate at HCM Strategists, a health and education consulting firm. Ashley holds a Masters in public policy from George Washington University, with a concentration in health policy, and a Bachelor of Arts degree in political science and psychology from Emory University.