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KEY POINTS

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  • Participation in Part D medication therapy management (MTM) programs is lower than predicted, and this has frustrated Part D plan sponsors and the federal government, especially considering MTM's success in some Medicaid and private sector programs.

  • MTM is defined as a systematic process of collecting patient-specific information, assessing medication therapies to identify and prioritize medication-related problems, and creating a plan to resolve them.

  • MTM's scope of services within Part D is evolving. This requires constant surveillance of the literature and CMS communications.

  • Under Part D, free MTM services are generally reserved for enrollees who meet criteria related to their annual Part D drug costs, number of prescription drugs, and prevalence of certain chronic diseases.

  • MTM is showing promise in other non-Medicare drug benefit programs.

  • The Patient Protection and Affordable Care Act (P.L. 111-148) authorized grants for "medication management services" in all practice settings (Section 3503), noting that such services will help manage chronic disease, reduce medical errors, and improve patient adherence to therapies while reducing acute care costs and hospital readmissions. However, funds were never appropriated for this section.

  • Part D's inherent structure makes it particularly challenging to create and sustain robust MTM programs. However, CMS research (2013) identified effective MTM practices of highly-effective drug plans.

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This chapter is adapted, with permission, from the author's original report, Medicare Part D's Medication Therapy Management: Shifting from Neutral to Drive, published by the AARP Public Policy Institute, June 2012. ©2012 AARP. All rights reserved. The author currently serves as Principal and Founder, Enhance Value, Bethesda, MD.

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BACKGROUND AND PROGRAM EXPECTATIONS

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Federal law requires Medicare Part D drug plan sponsors to offer medication therapy management (MTM) programs to help targeted enrollees avoid drug-related problems and optimize medication benefits. In 2006, such programs were hailed as a "win-win" proposition for plans, pharmacists, and beneficiaries.1 However, 8 years later, MTM participation is lower than predicted, and it is still not possible to evaluate whether Part D MTM programs are working as intended. This has frustrated Part D plan sponsors and the federal government, especially considering MTM's success in some Medicaid and private sector programs. This chapter proposes policy options for demonstrating and increasing MTM's effectiveness within Part D.

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For most people, the term "pharmacists' services" may conjure up traditional pill-counting and dispensing functions and nothing more. Since 2006, however, Medicare's voluntary prescription drug benefit, Part D, has played an important role in expanding the scope of such services. Part D plans must provide MTM programs to help eligible enrollees avoid drug-related problems and achieve desired clinical benefits from medications.2

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Medication therapy management is defined as a systematic process of collecting pa-tient-specific information, assessing medication therapies to identify and prioritize medication-related problems, and creating a plan to resolve them.3 Historically, MTM services represent a bundling of "pharmaceutical care" interventions. Pharmaceutical care is a patient-centered practice ...

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