In 2006, the Center for Medicare and Medicaid Services (CMS) established a general framework allowing sponsors to implement a Medication Therapy Management (MTM) program for its members. MTM is a comprehensive approach to improve medication use, adherence, and reduce the risk of adverse events; it is not disease-specific disease management. In 2010, after extensive analysis, MTM requirements were expanded for increased consistency among sponsors’ programs, and CMS pushed the service forward.
In November 2012, the Congressional Budget Office issued a statement summarizing the results of recent research estimating that greater prescription drug use by Medicare beneficiaries contributes to a reduction in Medicare’s spending for medication services. In recent years, comprehensive MTM legislation has been pushed to the back by other more pressing healthcare efforts: namely the Affordable Care Act (ACA) and Health Information Technology for Economic and Clinical Health Act (HITECH).
In 2013 and the coming years, Centers for Medicare and Medicaid Services would like to expand the access to better target the beneficiaries who most need MTM, and through improved data collection, be able to more specifically evaluate the impact of MTM at the beneficiary level. Today, each Medicare Part D sponsor is required to incorporate an MTM program into their plan’s benefit structure.
In June 2011, CMS initiated a two-year project to examine the impact of Part D MTM programs on the Medicare Part D beneficiary population, with a particular focus on specific high-risk populations with strong clinical incentive to maintain drug therapy. Interim reports show evidence of Medicare beneficiaries enrolled in MTM programs in 2010 – particularly those who received annual comprehensive medication reviews (CMR) – experienced significant improvements in drug therapy outcomes when compared to beneficiaries who did not receive any MTM services. This supports the hypothesis that the annual CMR may be one of the more crucial elements of MTM.
Recently, industry leaders sent a letter to CMS Innovation asking the group to clarify that pharmacists are providers for the purposes of participating in new delivery system models. Pharmacy has a critical role in the future of healthcare… Positive outcomes and cost savings are getting more attention in both policy circles and the marketplace, and pharmacy needs to continue its push for becoming a major participant in the effort to meet these two objectives.
More exciting news... Within the last month, U.S. Senators in Kansas, North Carolina, and Washington introduced legislation written to lower healthcare costs by helping more seniors better manage their prescriptions. The Medication Therapy Management Empowerment Act will allow seniors with any high-cost chronic illness to review all their medication and develop a plan of action with a pharmacist.
Hang on... Things are starting to get interesting.