CMS unveils updated MTM model
WASHINGTON — The Centers for Medicare and Medicaid Services (CMS) on Tuesday unveiled the latest enhancement to its model for testing medication therapy management (MTM) and its impact on health outcomes.
The five-year test of the Enhanced MTM model — launching Jan. 1, 2017 — is aimed at assessing the efficacy of offering prescription drug plans certain incentives will help achieve MTM program goals like improving compliance, adherence and proper use; reducing medication related problems; increasing patient knowledge of their medication regimen; and improving communication between patients, providers, prescribers and caregivers.
“As part of our approach to building a health care delivery system that results in better care, smarter, spending and healthier people, CMS will test changes to the Part D program to give prescription drug plans stronger incentives and flexibility to improve prescription drug safety and efficacy,” Dr. Patrick Conway, CMS’ acting principal deputy administrator and chief medical officer, said. “Through this model, we are hopeful that Part D plans will invest in medication therapy management and identify new, effective strategies to optimize medication use and improve care coordination in Medicare.”
There are three central elements to the Enhanced MTM model: regulatory flexibility that CMS hopes will allow for more individualized interventions, potential for payment for extensive MTM inteventions that might fall outside of a plan’s Part D coverage and a performance payment that takes the form of an increased direct premium subsidy, which would benefit MTM plans meeting a reduction benchmark in fee-for-service spending and fulfill the model’s quality and data reporting requirements.
The model will be tested in five regions: Region 7 (Fla.), Region 11 (La.), Region 28 (Ariz.) and Region 25 (Iowa, Minn., Mont., Neb., N.D., S.D. and Wyo.). Eligible regional PDPs can apply to change up their MTM offerings and look for ways to individualize outreach and engagement among their patients.
For the National Association of Chain Drug Stores, the Enhanced MTM model is a welcome change.
“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,” NACDS President and CEO Steve Anderson said. “That is why NACDS is advocating for the Medication Therapy Management Act (S. 776), and that is why NACDS has advocated consistently for MTM programs in the Affordable Care Act — including the passage and subsequent implementation of patient-centered comprehensive medication reviews in Medicare Part D plans, which will further reinforce the importance of patients taking their medications as prescribed.”
During the test, certain MTM program requirements will be waived in the participating regions, and PDPs who participate are expected to work closely with network pharmacies and local prescribers to identify the patients that would benefit most from MTM intervention, CMS said.
CMS plans to offer a webinar about the Enhanced MTM on Oct. 21, will make application materials available on its website.