CMS plan to boost MTM gains traction in Congress

“Better care, smarter spending, healthier people.”



Those were the goals set forth by the Centers for Medicare and Medicaid Services in September when it unveiled plans for a five-year federal experiment to gauge the effectiveness of expanded medication therapy management for Medicare patients. CMS’ Center for Medicare and Medicaid Innovation will launch the Part D Enhanced Medication Therapy Management pilot program in 11 states, beginning in January 2017, in a bid to spur Medicare Part D prescription drug plans in those states to boost their commitment to pharmacist-provided MTM services for their members.

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The long-term goal, according to the agency, is “to test whether providing Part D sponsors with additional payment incentives and regulatory flexibilities will engender enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures.”



The push to expand MTM services has gained traction at CMS — and within Congress — as its benefits as a tool for improving long-term patient outcomes and lowering health costs have become clear. Late last year, 44 members of the House, including 24 Republicans and 20 Democrats, sent a letter to Secretary of Health and Human Services Sylvia Burwell, urging the participation of retail pharmacists in the Enhanced MTM program, and the House Committee on Energy and Commerce Subcommittee on Health held a hearing on “Examining the Medicare Part D Medication Therapy Management Program.”



In their letter to Burwell, the house members noted, “we believe the proposed enhanced MTM model to be a positive step forward in improving the Part D MTM program. However, we also believe that without participation of retail community pharmacists, the testing of enhanced MTM models will fall short of achieving the maximum potential in terms of positive outcomes and impact on beneficiary health.”



Community pharmacy advocates laud the moves. “Studies conducted by entities including ... CMS, the Congressional Budget Office and the Medicare Payment Advisory Committee show — among other results — that improved medication use leads to better health outcomes for patients, including reduced mortality; the reliance on fewer healthcare services, such as hospital readmissions and emergency room visits; and more cost-effective treatment of chronic conditions,” NACDS noted.