CMS pilot extended to Part D MTM in 2017
A new, long-term pilot program from the U.S. Centers for Medicare and Medicaid Services’ Center for Medicare and Medicaid Innovation, set to launch in 11 states in January 2017, will gauge the effectiveness of an Enhanced Medication Therapy Management model.
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The program will include sweetened payments and other incentives to the Part D plans that “offer innovative MTM programs, aimed at improving the quality of care while also reducing costs,” according to CMS. The agency called the five-year effort to boost MTM services and evaluate their impact on patient outcomes and costs part of its “better care, smarter spending, healthier people approach to improving health delivery.”
Five Part D regions will participate in the pilot, encompassing 11 states, including Arizona, Florida, Iowa, Louisiana, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Virginia and Wyoming.
The long-term goal, according to CMS, 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.”
CMS called the program “an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination and strengthen system linkages.”
In a statement aimed at Medicare beneficiaries, CMS urged seniors to take advantage of MTM services if they’re offered by their Part D drug plan. Among the benefits “a pharmacist or other health professional” can provide through MTM, the agency tells beneficiaries, and “a comprehensive review of all your medications,” as well as counseling on:
How to get the most benefit from the drugs you take
Any concerns you have, like medication costs and drug reactions
How best to take your medications
Any questions or problems you have about your prescription and over-the-counter medication.
MTM also includes “a written summary of this discussion, including an action plan that recommends what you can do to make the best use of your medications,” CMS reports, as well as “a personal medication list that will include all the medications you’re taking and why you take them.”
Investing in pharmacy services
One factor behind CMS’ more aggressive push to promote a more hands-on, direct style of care for Medicare patients is the relatively sluggish adoption of the MTM concept by Part D prescription drug plans, according to Larry Kocot, former VP government affairs for the National Association of Chain Drug Stores, and currently head of KPMG’s new Center for Healthcare Regulatory Insight within its Healthcare and Life Sciences Practice.
“For a variety of reasons, MTM has not realized its potential in Medicare Part D,” Kocot told DSN. “Most Part D sponsors do not view MTM activities as central to their patient care strategies because incentives are not aligned sufficiently to drive them to look beyond MTM as a program requirement.”
“Indeed, MTM in Part D is currently included as an ‘administrative cost’ within Part D bids,” Kocot added. “As a result, plans actually have an incentive to economize on MTM to control costs, rather than invest in MTM to optimize therapy. By realigning the incentives and paying plans for MTM outside of the bid, CMS is trying to unleash the potential for advances in MTM to more directly benefit beneficiaries and the Medicare program.”
To spur innovation, improve long-term patient outcomes and encourage adoption of MTM, said Kocot, “the first step is to realign the incentives.” CMS’ new pilot program, he said “will test whether the incentives are sufficient to achieve the goals of the program.”
“The exciting part of this demonstration model is that CMS will be developing direct and useful evidence to apply to continually improve the program,” he noted. “With incentives realigned and plan sponsors leveraging the important role of pharmacists within the program, MTM may actually become a cornerstone of the Medicare Part D benefit.”
Pharmacy groups quickly embraced CMS’ plan. “NACDS and our allies know that MTM can go a long way toward helping patients get and stay healthy, and toward addressing the $290 billion in annual costs that are associated with not taking medications as prescribed,” said Steve Anderson, president and CEO of NACDS. “That is why NACDS is advocating for the Medication Therapy Management Act [S. 776], and ... for MTM programs in the Affordable Care Act.”
“We want to identify exactly how this fits into a comprehensive vision to help patients benefit from MTM — particularly those patients who have the most to gain from improved medication use,” Anderson added.
The renewed impetus for pharmacist-provided MTM services comes amid growing support in Congress for a higher level of pharmacy-based patient care, according to the Patient Access to Pharmacists’ Care Coalition, an advocacy group whose members include NACDS, the National Community Pharmacists Association, the American Pharmacists Association and the National Alliance of State Pharmacy Associations. That support is seen in the steady rise in the number of lawmakers who have added their names to the Pharmacy and Medically Underserved Areas Enhancement Act (S. 314/H.R. 592), a piece of legislation that would expand Medicare beneficiary access to pharmacist-provided patient care services in medically underserved communities.
“Cosponsorship in the House of Representatives recently eclipsed 230, confirming that a majority of House members recognize the value that pharmacists can play in providing healthcare services to underserved communities throughout the nation,” PAPCC reported in early November. “The Senate’s support is also strong, with cosponsorship now equaling 33 [senators].”