January 15, 2014
Timing ideal as CMS proposed rule and proposed legislation would enhance MTM eligibility in Medicare
Arlington, Va. – An article in the January 2014 Journal of Managed Care Pharmacy bolsters support for medication therapy management (MTM) as a key to better and more affordable healthcare, and backs reform of eligibility criteria to make MTM available to more Medicare beneficiaries. Laura Miller, senior economist with the National Association of Chain Drug Stores (NACDS), co-authored the article, titled “Should Eligibility for Medication Therapy Management be Based on Drug Adherence?”
The article suggests that MTM services would reach more patients with a history of not taking their medications correctly if eligibility requirements were changed to include Medicare Part D beneficiaries who take two prescription drugs. Currently, patients must take eight prescription medications to be eligible for MTM services under most Part D plans.
“Our findings suggest that current MTM eligibility criteria are not optimally targeted to capture underuse of and poor adherence to evidence-based medications for prevalent chronic diseases in the elderly,” the article concludes.
This latest article supplements a growing body of evidence that improving medication adherence – including use of MTM to help patients take medications as prescribed – helps to enhance patient health and improve healthcare affordability. Reports by the Congressional Budget Office (CBO) and the Centers for Medicare & Medicaid Services (CMS), as well as articles in Health Affairs and the Journal of American Pharmacists, offer further support that appropriate medication use can improve health while lowering costs.
The increasing focus on MTM also has included action in the legislative and executive branches of government, with initiatives underway to refine eligibility criteria for MTM within Medicare. Bipartisan support continues to grow for the proposed Medication Therapy Management Empowerment Act of 2013 (H.R. 1024 and S. 557). The legislation enjoys the co-sponsorship of 159 members of the U.S. House of Representatives and 30 members of the U.S. Senate – more than 35 percent of the Congress. In addition, the Centers for Medicare & Medicaid Services (CMS) projects that MTM eligibility changes included in its Medicare Part D proposed rule published last week could increase the number of eligible beneficiaries from 2.5 million to 18 million.
“These efforts by Congress and the Administration to improve access to MTM are good public policy and wise strategies for improving the quality and cost-effectiveness of public health,” said NACDS President and CEO Steven C. Anderson, IOM, CAE. “Pharmacists are widely trusted healthcare professionals with extensive education. They are trained medication specialists who work collaboratively with physicians and with other healthcare professionals to help patients use medicines safely and stay healthy.”