CMS unveils enhanced MTM program

It has been a decade since the Medicare Modernization Act took effect, creating Medicare Part D and tacking on mandatory medication therapy management (MTM) services to encourage the appropriate use of drugs by older adults.

In 2010, the Centers for Medicare & Medicaid Services (CMS) significantly tweaked MTM, providing changes in targeting criteria and giving the program more consistency. Three years later, the comprehensive medication review (CMR) as part of MTM services became a mandate for every program.

This evolution will be capped by Part D Enhanced MTM slated for January 1, 2017. Introduced by CMS’ Center for Medicare and Medicaid Innovation (CMMI) for Prescription Drug Plans (PDPs) only [Medicare Advantage-Prescription Drug plans (MA-PDs) and PDPs participate in the current MTM program], it should provide more flexibility along with prospective and performance incentives.

Enhanced MTM

CMMI’s overall goals for Enhanced MTM are:

• Improving compliance with medication protocols through appropriate prescribing and proper use.

• Reducing medication problems.

• Increasing patient knowledge of the drugs they take.

• Improving communications among prescribers, pharmacists, caregivers and patients.

Kurt Proctor, senior vice president, strategic initiatives, National Community Pharmacists Association, applauds the enhanced model emphasizing its incentives for prescribing appropriate drugs and for reducing other healthcare costs, such as fewer hospitalizations and emergency department visits. However, he acknowledges that MTM results in higher drug utilization and costs because of increased adherence and pharmacist participation.

The Congressional Budget Office estimates that a 1% increase in the number of prescriptions filled would cause Medicare’s spending on medical services to fall by roughly 0.2%.

Proctor also looks forward to more flexible eligibility criteria so that those who really need MTM services are targeted, not just because they meet requirements.

Agreeing with Proctor, Mary Jo Carden, vice president, government and pharmacy affairs for the Academy of Managed Care Pharmacy (AMCP), says, “MTM may not be the best way to go for some beneficiaries even if they meet criteria requirements, but those most in need should receive it.” 

Michael Johnsrud, senior vice president, health economics and outcomes research for Avalere, a healthcare consulting company, says enhanced MTM will give plans the ability to design creative MTM programs to solve over- and under-identification of eligible members, target them appropriately, leverage services and benefits and improve outcomes. “It should enable pharmacists to improve drug utilization, control side effects and increase adherence,” he says.

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