An article in the distinguished peer-reviewed health journal Health Affairs last week reported on an NACDS-supported study that found patients’ enrollment in Medicare Part D medication therapy management (MTM) programs varies according to the program’s eligibility criteria.
NACDS is always looking for ways to work with CMS to improve patient care and reduce overall all costs.
The study showed that enrollment rates in MTM programs among stand-alone prescription drug programs and Medicare Advantage drug plans averaged only 10 percent. In addition, enrollment variation across plans—from less than 0.2 percent to more than 57 percent—showed a direct correlation to the restrictiveness of the plans’ eligibility criteria. NACDS CEO Issue Update spoke with one of the authors of the study, NACDS Senior Economist Laura Miller, on the findings.
Q: The study shows plan sponsors have a great deal of latitude in setting eligibility requirements for MTM services under Medicare Part D. How does that latitude affect beneficiaries?
A: Plan sponsors can make eligibility restrictive or expansive—those with more restrictive criteria have fewer eligible and fewer beneficiaries getting MTM
Q: The study found that most Medicare Part D sponsors have chosen to provide MTM services to narrow segments of their enrollment pools. Why?
A: At least for prescription drug plans (PDPs), MTM services are a cost but neither PDP plans or Medicare Advantage plans are directly reimbursed by Medicare for the costs of providing MTM. Because financial incentives are not aligned with potential benefits of the services, plans are more inclined to restrict MTM services.
Q: How can CMS’s new Part D Enhanced Medication Therapy Management model improve the MTM program?
A: If CMS is able to align financial incentives for plan sponsors, they will use MTM any time it improves patient outcomes or reduces overall costs.
Q: Why is improving MTM benefits essential for patients, especially on a broader scale?
A: MTM has the potential to improve patient outcomes and reduce medical expenditures. The most common MTM service, an annual medication review, is particularly useful for patients taking multiple medications—to make sure they are not taking duplicative drugs, or drugs that interact with each other. Another important result of the annual medication review is to identify which, if any, drugs are not being taken that have been prescribed to treat particular conditions. Taking prescription medication correctly is an important part of a patient’s medical treatment and can both reduce costs and improve the patient’s health.
Q: Were you surprised by the results of this study?
A: We weren’t actually surprised at the correlation of eligibility requirements with enrollment. I think it’s pretty obvious that if you make eligibility harder, you are going to have fewer enrollees. We were surprised at how much variability we saw in enrollment rates.
Q: What will NACDS need to do going forward to work with CMS on making these improvements?
A: We will continue to provide as much information and analysis as we can to show the value of MTM services and to determine the best structure or structures for the MTM program. NACDS is always looking for ways to work with CMS to improve patient care and reduce overall all costs.
