Changes for MTM, Short-cycle Dispensing Included in Medicare Revisions

On April 5, 2011, the Centers for Medicare & Medicaid Services (CMS) released a final rule on revisions to Medicare for 2012 and the Final 2012 Advance Notice and Call Letter on changes to Medicare Advantage and Medicare Part D for 2012.

Pharmacy-related provisions in the final rule include medication therapy management (MTM) programs and short-cycle dispensing in long-term care facilities (LTCFs), according to the American Pharmacist Association (APhA).

In terms of the Medicare Part D MTM programs, the final rule reconciles Affordable Care Act (ACA) provisions with existing regulations that were effective in 2010. The plans’ MTM benefit for targeted beneficiaries must continue to have opt-out enrollment for MTM services in addition to including an annual comprehensive medication review (CMR), targeted medication review, and summary of the patient’s visit, noted Marcie Bough, PharmD, APhA’s Senior Director, Government Affairs, in a statement.

Effective January 1, 2013, patients receiving a CMR will be provided a Medication Action Plan (MAP) in a standardized format. Plans will also be required to perform a quarterly assessment of all at-risk individuals not already enrolled as a targeted beneficiary in an MTM program. CMS did not finalize MTM-related provisions for LTCFs, and will work with stakeholders on those, according to APhA.

CMS also announced plans to delay implementation of its proposed Medicare Part D long-term care "short-cycle" rule for one year and to modify the requirements to be less onerous for independent pharmacies, according to the National Community Pharmacists Association.

"Medicare officials are doing the right thing for patients and the long-term care pharmacists who serve them," said NCPA Executive Vice President and CEO Douglas Hoey, RPh, in a press release. "Pharmacists are committed to working with Medicare and other health plans to reduce costs, while maintaining quality care. However, there is no creditable evidence that this proposed move to shorter dispensing cycles would reduce costs and, in the end, we fear it could actually increase costs for taxpayers. That's why a broad coalition of lawmakers and health care providers is urging CMS to hold off on the program to allow for data gathering necessary to implement this program intelligently."

In addition to delaying implementation of the short-cycle rule from Jan. 1, 2012 to Jan. 1, 2013, the final rule also would ease the requirements on how LTC pharmacies account for dispensed, but unused, medications. The final rule also requires that LTC pharmacies dispense solid oral doses of brand-name medications in 14-day-or-less supplies, compared to the more onerous 7-day-or-less mandate in CMS' proposed rule.

Prior to the announcement, a number of leaders from health care groups and government officials expressed concerns regarding the merits and justification for the short-cycle rule, and urged CMS to postpone implementation of the rule until a more proper, comprehensive analysis could be conducted.

"This additional time does two important things," Hoey added. "First, it gives CMS more breathing room to fully reconsider this policy. For example, NCPA and others continue to advocate that the agency seek high-quality, unbiased data to fully evaluate the cost impact of the short-cycle rule before moving forward with it. Second, this window gives independent pharmacies and other LTC providers additional time to make the considerable changes in workflow and staffing that may be necessary to comply with the final requirements. We deeply appreciate the support of this broad coalition of lawmakers and health care providers."

Other changes in the final rule to Medicare for 2012 include standardization of the exceptions and appeals process for plans, revisions to the definition of “pharmacist,” payment for multi-ingredient drug compounds, and the continued steps in the closing of the Part D coverage gap.