RT Book, Section
A1 Miguel, Alexander
A1 Nacin, Cynthia R.
A2 Whalen, Karen
A2 Hardin, Heather C.
SR Print(0)
ID 1150195411
T1 Medicare Part D’s Medication Therapy Management and Other Related Services
T2 Medication Therapy Management: A Comprehensive Approach, 2e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781260108453
LK accesspharmacy.mhmedical.com/content.aspx?aid=1150195411
RD 2024/04/20
AB KEY  POINTSParticipation  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.The  Centers  for  Medicare  and  Medicaid  Services  (CMS)  defines  MTM  as  a  patient-centric  and  comprehensive  approach  to  improve  medication  use,  reduce  the  risk  of  adverse  events,  and  improve  medication  adherence.The  MTM  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.The  Centers  for  Medicare  and  Medicaid  Innovation  (CMMI)  have  developed  the  Enhanced  MTM  Model  to  allow  sponsors  regulatory  flexibility  and  financial  resources  to  design  MTM  programs  that  best  fit  their  beneficiaries’  needs.  The  goal  of  this  innovative  MTM  model  is  to  align  the  interest  of  Part  D  sponsors  and  CMS.MTM  is  showing  promise  in  other  non-Medicare  drug  benefit  programs.The  Patient  Protection  and  Affordable  Care  Act  (PL  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.